Test 3 (OB)

Statistical Data Birth rate Maternal Mortality Pregnancy related deaths Infant Mortality Pediatric mortality

number of live births per 1000 people in a given population number of deaths from cause r/t or aggravated by pregnancy or management of pregnancy during pregnancy cycle (including 42 day PP pd) per 100 000 live births; Pregnancy related deaths: death of woman while pregnant or within 1 yr of termination of pregnancy from any cause aggravated by pregnancy or r/t it Infant: # of deaths in infants under 1 yr per 1000 live births in a give population (neonatal mortality- 28 days, perinatal: both neonatal and fetal deaths, fetal death: in utero at 20+ wks gestation) Most common cause is injury

- Indications for induction: __ __, preeclampsia, PROM, postterm, __, IUFD; induce w/ __; complications of oxytocin: __ of uterus (more than __ contractions in __ mins averaged over 30 minute window; leads to decreased __ __, bad FHR), water intoxication (oxytocin is __ in large doses, decrease __ __, leads to water intoxication), __ __, uterine atony post birth -Complementary induction methods include manual dilation of cervix w/ __, intercourse, __ stimulation, herbs/castor oil, enemas (no recommended, can leads to __), acupuncture -Uterine activity in labor: frequency, duration, intensity, __ __, __ __, __ units -Caput (__; goes away in 2-3 days) w/ __; forceps: caput, cephalohematoma, mom can have __, baby can have __ injury -Transverse incision on lower uterine segment is preferred b/c it is the __ part of involves less __ __; easiest to repair, less likely to __ during subsequent pregnancies, dec risk of __ of bowel to incision line -After baby is born, they can give mom __- morphine in __ cath; monitor pulse ox, vitals; duramorph lasts for __ hrs, side effects include itching, can give __ or __, may be nauseous; if not duramorph, mom can get __ pump -After c birth- monitor recovery VS; assess q 15 mins for at least 1 hr: __ __, fundus, incision, return of sensation, urine, __, pain __&__ -VBAC: indicated w/ one or two previous birth and __ __ uterine incision, clinically __ pelvis, previous c birth w/ undocumented scar unless its likely a __ incision, absence of hx of previous uterine __; avoid __ agents, use __ w/ caution; greater change of VBAC success if mom is less than __ lbs

DM, IUGR, oxytocin, tachysystole, 5, 10, placental perfusion, antidiuretic , urine output, uterine rupture foley, nipple, hemorrhoids resting tone, relaxation time, Montevideo conhead, VAB, lacerations, brachiplexus thinnest, blood loss, rupture, adherence, duramorph, epidural, 24, Benadryl, Nubain, PCA peri pad, SpO2, IO low transverse, adequate, classical, rupture, ripening, pitocin, 200

Classes for family during pregnancy: share info about pregnancy, birth, __ mechanisms, and choices available for woman and __ person; sibling prep classes can assist with decreasing __ and __, includes care of new baby, practice __ baby, changing diapers, tour of __/__

coping, support, anxiety, riverly, holding, nursery, room

Additives: can dec __ and inc effectiveness of __ when given simultaneously; tranquilizers have no effect on __, but provide relief and allow for lower dose of __ (promethazine, __, __); can lead to __ Regional anesthesia and analgesia: temporary loss of __ produced by injection anesthetic agent (__ anesthetic) into direction contact w/ __ __; epidural relieves pain associated w/ __ stage of labor by blocking __ nerve supplying the __; regional analgesia obtained by injection __ w/ small amount of __ agent in __ space; can also use __ injection of opioids (__ space), which results in more effective pain relief over subsequent __ hrs after birth -Anesthetics for regional blocks: blocks conduction of __ impulses from __ to CNS by preventing generation of an __ __; types of nerve fibers are differently __ to various anesthetics; absorption of local anesthetic depends on __ of area, __ of tissue, ___, cardiovascular problems -Types: esters and amides; ester is __ (Novocain)/__ (Pontocaine), rapidly __; amides include __, mepivacaine, bupivacaine; amides are more __ and are __ acting, readily cross __, measured in fetal __; pain relief effects of __ is similar to other amides, but __ effects are slightly lower, thus increasing rates of __ births -Adverse reactions to anesthetics: mild- __, tinnitus, apprehension, __, __ taste; mod- N/V, __, muscle __; severe: LOV, coma, severe __, __ , resp depression, code -Neonatal neurobehavioral effects: more neuro impairment occurs in _ _ resulting from normal birth process than from __ complications

anziety, analgesics, pain, opioids, promazine, hydroxyzine, sedation sensation, local, nervous tissue, first, sensory, uterus, fentanyl, anesthetic, epidural, intrathecal, subarachnoid, 24 nerve, periphery, AP, sensitive, vascularity, pH, dehydration procain, tetracaine, metabolized, lidocaine, powerful, longer, placenta, cirulation, ropivacinae, bloackage, vaginal palpitations, confusion, metallic, hypotension, twicth, hypotension, braducardia NB, epidural

Psychologic Response of Expectant Family 1st trimester: FEMALE: feels of __, mom focuses on herself and pregnancy, may experience __ changes; MALE- may feel __ then __ __, may be confused by mom's mood changes, pregnancy doesn't seem real 2nd trimester: __ occurs, helps mom think of baby as __ person, mom gets excited, __ helps mom prepare; MALE- starts to understand __ as he watches/feels baby; must discuss his __ Third: __ about pregnancy, anxiety about birth, __, pds of __ bursts; MALE- pride Psychologic tasks of mom: ensuring __ passage through pregnancy, labor, birth, seeking __ of child by others, seeks __ and __ of herself as mother to baby, learning to give on behalf of child

disbelief, mood, excited, left out quickening, separate, introspection, involvement, role pride, nesting, energy safe, acceptance, commitment, acceptance,

Twins Fraternal (__): 2 placentas, 2 __, 2 __; chances __ w/ maternal age Identical (__): originate from division of fertilized __ at different stages of ealy development, after zygote consists of __ of cells; if division occurs within __ days of fertilization, __ of everything will form (may have 1 or 2 __), if division __-__ days after fertilization, __ embryos develop if different __ sacs, which will be covered with a common __; if amnion has already developed (__-__ days after fertilization), division causes __ embryos w/ common __ and __ __

dizygotic, chorions, amnions, increase monozygotic, ovum, thousands, 4, 2, placentas, 4-8, 2, amnion, chorion, 8-12, 2, chorion, amniotic sac

Placental Function Metabolic activities: produced __, FAs, cholesterol, enzymes, breaks down __, stores __/iron Endocrine function: placenta produces hormones that are vital to survival of fetus, including __, human placental __, estrogen, __; hCG prevents shedding of uterine __, keeps corpus __ intact; hCG stimulates __ in males, leading to sex development; hCG presents in blood __-__ days after fertilization, detectable amount in urine at time of missed __; progesterone increases secretions of __ __ and __ to provide appropriate __ matter for developing blastocyst, must be present for __ to occur, blocks uterine __; estrogens cause enlargement of __, breast, breast __ tissue, increase __ Immunologic function: placental and embryo are transplants of living tissue within same species, so they're considered __; placenta and embryo appear exempt from __ reaction by host

glycogen, substances, glycogen hCG, lactogen, progesterone, lining, luteum, testosterone, 8-10, menses, fallopian tubes, uterus, nutritive, implantation, contractions, uterus, glandular, vascularity homografts, immunologic

Intrapartum maternal assessment: demos, LMP, physician/midwife, personal __, HPI, problems in __ pd, pregnancy data, method for __, __ education, birth __, status of __ __ Intrapartum high risk screening: note any factors associated w/ high risk conditions, including __ presentation, __/__/__, __ staining amniotic fluid, __ ROM, __ placentae, failure to __ in labor, precipitous labor, __ cord, fetal heart abnormalities, __ rupture, diabetes, preeclampsia, STIs Intrapartum physical and psychosocial assessment: when labor is progressing very quickly, critical assessments include significant __ hx, __ risk factors/problems that occurs during pregnancy, maternal __ __, labor __, fetal __, labs Methods of evaluating labor progress -Contraction assessment: can place hand on __ __, determine frequency by counting from __ of one contraction to beginning of next; determine how much the __ can be __ to determine intensity; electronic monitoring can be done externally (position __ against __ of uterus and hold in place w/ elastic band; toco responds to __) or internally w/ __ __ __ (provides accurate measurement of contraction __ and ___ if hard to detect externally; use once membranes __ -Cervical __ via vag exam

hx, prenatal, feeding, prenal, preferences, amniotic membrane abnormal, hydramnios, polyhydraminos, oligohydraminos, mechnium, premature, abruptio, progress, prolapsed, uterine pregnancy, high, VS, status, status uterine fundus, beginning, fundus, indented, tocodynamometer, fundus, pressure, intrauterine pressure catheter, intesnsity, FHR, rupture dilation

D/C Prep: -Criteria: assess mom's __ and __ condition, NBs adjustment to __ life, need for __ resources; assess parents __, expectations, beliefs and provide __ __ and teaching; ensure __ are normal, normal __ of uterus, appropriate amount of __ w/ no evidence of infection (know signs of __), episiotomy well ___ w/ dec in edema/__, ability to perform __ and apply meds to __ area, ability to void/__; has received __, __, and rhogam if indicated -Teaching: review recommended __, need for adequate __, need to avoid __, recommendations about __; give info about __ needs of mom; have mom demonstrate proper __ techniques; give guidance about when to bathe baby in __, when baby will need __, when to schedule PP appointment and NB __ -Considerations for F/U care: early d/c can increase risk for __ __ and difficulty __ (not well established before 48 hrs), opportunities for mom/baby __ can be compromised, inc risk for __; vag birth women are seen at __ wls, c births seen at __ wks; give PPD screen before __ wk check up if hx of __ disorders; late preterm (__-__ wks) are at greater risk for inc __ and __ b/c they aren't physically mature and are more prone to complications (often readmitted for __) -Telephone f/u: call is made __ days after d/c, lasts __mins, call is __ directed; nurse must ask __ ended questions; can also call after __ __ to answer questions, give information, make referrals PRN -Home visit: if d/c earlier than __ hrs, they'll get __ home visits; schedule additional visits PRN

physiological, psychological, extrauterine, outside, knowledge, anticipatory guidance, VS, involution, lochia, infection, appriximated, bruising, pericare, perineal, fart, TDAP, rubella exercises, rest, overexertion, sex, nutritional, feeding, tub, immunizations, follow up PP hemorrhage, BF, bonding, depression, 6, 2, 6, mental, 34-37, morbitidy, mortality, jaundice 3, 20, goal, open, home bisit 48, 3,

Birth classes - Programs for preparation, class named by method: Lamaze (controlled muscle __, specified __ patterns), kitsinger (__/__ breathing, sensory memory), bradley (__ coached birth, focuses on controlled __ for natural birth), hypnobirthing (breathing/__ techniques to work in __ harmony to make process easier and more comfortable - Relaxation techniques: allows woman to conserve __ and __ muscles to work more effeciently; __ relaxation technique, __ __ relaxation -Breathing techniques: keeps mom/baby __ and helps mother relax and focus __ appropriately

relaxation, breathing, abd, chest, partner, breathing, relaxation, neuromuscular energy, uterine, touch, sequential, muscle oxygenated, attention

-Latent: __-__ cm, can still be home during this phase; orient pt to __, encourage __ and __ interventions, give fluid/__ chips, __ compress if vomiting, make sure she __ prior to being on monitor b/c __ __ can inhibit descent of head -Active: __-__ cm, q __ mins for an hour; encourage breathing/relaxation; mom feels __, fatigued, and restless; __ __ increases w/ dilation; calm environment, massage, __ techniques, __ compress, change positions -Transition: __-__ cm; mom gets angry, most painful but __ part; fear of being alone, encourage __ between contractions, may be on all 4s -2nd stage: traditional vs labor down -Pull on vacuum w/ __; baby is more at risk for __, which disappears in 2 wks-__ mos, but increases incidence of __ -If mom tears midline, she can tear right into __ (prevent with __ episiotomy) -__-__ units of oxytocin after placenta is delivered -Check following q __ mins for first 1-2 hrs PP: ___, uterine __, lochia (saturated pad in __ mins is excessive), bladder, __ -Interventions for uterine atony: do __ __, express clots, void/___; give oxytocin or __ (.2 mg __ q 2-4 hrs or .2 mg PO; CI w/ __); can give prostaglandins (__ (Hemabate)), buts uts CI w/ cardiac, pulmonary (__) -Pain/stress decreases available __ to fetus (increased maternal O2 __, __ release causing vasoconstriction, maternal __)

0-3, surroundings, ambulation, nonpharmacological, ive, cold, voids, full bladder 4-7, 5, helpless, bloody show, relazation, cold 8-10, shortest, rest, pull legs up, push for 8, take breath and do again repeat 3x vs/ don't push until head is really far down, then they breathe out while pushing, don't hold breath contractions, cephalohematoma, 2, jaundice rectum, mediolateral 10-20 15, VS, tone, 15, perineum fundal massage, cath, methergine, IM, HTN, carboprost, asthma O2, consumption, catechilamines, acidosis

Late PPH: usually occurs __-__ wks after birth, most commonly a result of __ (failure of uterus to return to normal __) or retention of __ __; faulty implantation in less __ __ uterine segment or __ may contribute; fundal height will be __ than expected, lochia won't progress from __ to __ (rubra lasts for longer than __ wks); confirm retained placenta w/ __ (this prevents contraction) Nursing: -For all complaints of perineal pain, examine perineal area for signs of __ (bruising, edema, extreme __); dec risk of vaginal/vulvar hematomas by applying ice to perineum during first __ after birth and for next __-__ hrs; -If uterine is __, try to push out __ when massaging; if slow, steady blood loss, weight pads, monitor VS q __ mins -As blood gets depleted, put legs elevated at __ deg to promote blood return; give __ fluid or blood (only if __ __ are unstable or __ can no longed replace loss); monitor for fluid __ -After PPH, check for signs of anemia (fatigue, __, headache, __ changes in pulse/BP, changes in __); monitor __ __ to assess kidney perfusion -PPH associated w/ __, so watch for signs -Tell mom to rise __ at home, eat food high in __, count __ to recognize problems w/ excessive blood loss; get help because mom will be very __

1-2, subinvolution, size, placental fragments, vascular, lower, infection, higher, rubra, alba, 2, ultrasound hematomas, tenderness, hour, 8-12 boggy, clots, 15 30, crystallized, VS, fluid, overload, pallor, orthostatic, Hct, urine output PPD slowly, iron, pads, tired

BF concerns: if NB weight loss since birth is __ or more, nurse should assess for signs of __; r/f for poor breastfeeding include: maternal __, primiparity, __ mom, use of pacifiers, LBW -Nipple not graspable: flat/inverted (wear breast __, grasp nipples between __, use __ to draw out), engorged (feed more __, empty breasts), large breasts (__ up, use __ hold) -Engorgement: missed feedings (fee q __-__ h, empty completely, avoid excess __, put __ compresses on just before feeding, use __ compresses in between feedings), breasts not emptied (massage/use __ cloths before feeding, __-__ mins per side, pump after), inadequate let down (relax, massage, __ compresses, express in __, use __ before baby to encourage letdown); baby sleepy (put __ on lips to stimulate); s/s: hard, painful, warm, __/__, __-like (not normal fullness that occurs in first __ hrs) -Inadequate let down: relax, __ breasts, drink __, __ nipple before feeding; r/t __ or __ -Cracked nipples: ensure proper __, feed more __, avoid __, express milk after feeding and allow it to __ on nipple -Plugged ducts: poor position, __ pressure on breast (use __ bra, wear __ bra, don't scrunch shirt under __ when BF); heat/massage -Sore nipples: __ position (ensure proper __), baby chewing on nipple (get baby on breast using __), baby sucking on __ of nipple -Some discomfort occurs with start of BF (occurs around day __-__), then recedes; pain past first week demands attention, encourage mom to __ positions -Alcohol free for __-__ hrs, b/c it can reduce supply

10%, dehydration, obseity, young shells, fingers, pump, prop, C 1/5-3, stimulation, warm, cold, warm, 10-15, warm, shower, pump, milk, shiny/taut, gravel, 24 fluids, stimulate, fatigue, stress position, frequently, soaps, dry external, large, sports, arm poor, alignment, rooting, end 3-6, rotate, 3-4

Preembryonic development: first __ days after conception are called __ stage; development after __ can be divided into cellular multiplication phase and cellular __ phase Cellular multiplication: begins as __ moves through __ tube toward __; takes __ days; zygote enters pd of rapid __ divisions (__), cells are blastomeres, held together by zona __; blastomeres form ball of __-__ cells, called __, which enters uterus, intracellular fluid of __ increases, creating a central __ that contains the __, outer layer is trophoblast Implantation (__): trophoblast attaches itself to surface of __ for further nourishment; commonly attaches to __ part of posterior uterine wall, lining of uterus __ below implanted __; __ causes endometrium to thicken and inc vascularity Cellular differentiation -Primary germ layers: 10-14 days after conception, the __ cells differentiate into primary germ layers (__, __, __) -Embryonic membranes: form at time of ___; membranes protect and support __ as it grows/develops in uterus -Amniotic fluid: acts as __ to protect embryo; helps control __, permits symmetric __ growth and development of __, prevents adherence of __/__ to amnion to prevent free movement, allows UC to be free of __; slightly __ and contains different __ and cells; 10 wks-__ mL, 16 wks-210 mL, 28 wks- ___ mL; oligohydraminos- less than __ ml, polyhydraminos- more than __ mL

14, preembryonic, fertilization, differentiation zygote, fallopian, uterus, 3+, mitotic, cleavage, pellucida, 12-32, morula, morula, cavity, blastocyst nidation, endometrium, upper, thickens, blastocyst, progesterone blastocyst, endoderm, mesoderm, ectoderm implantation, embryo, cushion, temp, external, fetus, fetus/embryo, compression, alkaline, nutrients, 30, 700-1000, 400, 2000

Risks to Adolescent mother: - Physiological risks: teens older than __ who receive early, thorough __ care are art no greater risk during pregnancy than those who are __; teens usually begin prenatal care __ than other age groups, so risks include __ births, __ infants, __ __ anemia, preeclampsia; prenatal care is __; 15-19 have high rate of __, which can harm fetus -Psychological risks: can interrupt adolescent __ tasks, the outcome of which will affect both mom and baby's __ -Sociologic risks: forced into adult roles before completing adolescent __ __ can result in prolonged __ on parents, lack of __ relationships, lack of __ and __ stability, lack of education; the amount of __ the pregnant teen receives is a critical factor in the way she handles __ and __ -Risks for child: parents aren't __ or __ prepared for kid; high rates of family __, bad neighborhoods, high rate of __ problems, kids are less likely to succeed in school and have higher rates of __ and __ Partners of adolescent moms: males see pregnancy as __ as it has poor impact on their goals; mom/dad commonly have similar __ backgrounds and have similar __ levels; girl will choose __ to be primary support person during birth; kids whose fathers are __ and __ are more likely to have good self-esteem, do well, avoid trouble Reactions of family/friends to teen pregnancy: __ in fam that fosters education/career goals, so many in these families will choose __; in populations where teen pregnancies are common, family/friends will be more __; commonly tell __ first, and mom supports/helps with __ making

15, prenatal, 20, later, preterm, LBW, iron deficiency, critical, STIs developmental, furutres developmental tasks, dependents, stable, economic, social, nutriting, pregnancy, motherhood economically, developmentally, instability, behavior abuse, neglect negative, economic, education, mom, involved, loving, shock, abortions, supportive, mom,decision

Amniotic fluid analysis: __-__ wks gestation; used to detect fetal abnormalities or to determine fetal __ maturity in 3rd trimester; use __ to determine __/__ position, clean skin w/ __, withdraw fluid w/ needle -Evaluation of fetal health: concentrations of certain substances in amniotic fluid provides info about __ __ of fetus; __ accurate in diagnosing __ abnormalities -Eval of fetal lung maturity: fetal lung maturity determination in conjunction w/ __ age is important when making decisions regarding timing of birth for women w/ complications; __ is composed of __, so fetal lung maturity can be determined by __ ratio, which are 2 components of surfactant; __ appears when fetal lung maturity has been attained (__ wks), so if this is present, risk for RDS is low; CVS: involves obtaining small sample of __ __ from developing __; can do 1st trimester diagnosis of genetic, metabolic, __ studies; either __ or __; typically performed at __-__ wks gestation; can cause ROM, leakage of __ fluid, bleeding, __ infection, maternal tissue contamination of specimen; can't detect __ because its too early in pregnancy; do continuous __ to avoid puncturing baby

15-16, lung, ultrasound, fetal/placental, betadine health status, 99%, genetic gestation, surfactant, phospholipids, L/S, phosphatidoglycerol, 35 CV, placenta, DNA, transvervically, transabdominally, 10-12, amniotic, intrauterine, NTD, ultrasound

Discomforts during pregnancy 1st trimester -N/V: usually occurs in __ trimester, may develop __ to specific foods, may experience __ when rising in morning, but can also have it through __ and __; elevated __ is major factor, but relaxation of __ muscle of __, fatigue, emotions may also play a role; __ and __ may help; contact HCP if vomiting more than once a day or showing signs of __, like dry mouth and concentrated urine; __ can have harmful effects on fetus; consider __ __ if it doesn't subside by __ wk of pregnancy (can lead to __ __, dehydration, __ imbalance); don't go __ for 2 hrs after eating, drink __ in between meals, dry __/__ before getting up in morning -Urinary frequency: occurs early in pregnancy and again during __ trimester b/c of pressure the uterus puts on __; tell HCP if burning, pain, __ (signs of __); don't dec fluid to prevent __; maintain __-__ 8 oz glasses daily, empty bladder q __ h when awake to dec risk of leakage and __ -Fatigue: usually resolves by end of __ trimester -Breast tenderness: occurs early and continues through __; inc levels of __ and __ contribute to soreness and tingling of breasts and inc __ of nipples -Inc vag d/c (_): white d/c r/t ___ of vag mucosa and inc mucus production by __ glands; increases risk of __ infection -Nasal __/__: elevated estrogen produces __ of nasal mucosa, resulting in obstruction (tx w/ __ air vaporizers and normal saline, not __) - ___: excessive, bitter saliva; suck __ candy or chew gum

1st, aversion, nausea, day, evening, hcg, smooth, stomach, ginger, acupressure, dehydration, antiemetics, HG, 16, weight loss, nurttion, supine, fluid, toast, crackers third, bladder, bleeding, infection, frequency, 8-10, 2, infection 1st, pregnancy, estrogen, progesterone, sensitivity leukorrhea, hypertrophy, endocervical, yeast stuffiness, epistaxis, hypertrophy, cool, decongestants ptyalism, hard

- Breasts: size increase noted around __ wks, become __, may have __ in 2nd/3rd trimester; nipples become __, striae, __ veins more prominent, __ may be present after __ wk; breasts less firm -Nasal mucosa is __ b/c of estrogen; may have __ of __ tissue b/c of estrogen, pale indicates __ -Abd: striae, __ __, 10-12 wks- fundus slightly above __ __; 20-22 wks: fundus at __; 28 wks: fundus __ fingers above umbilicus; 36 wks: fundus just below __ cartilage; size of __ should be consistent w/ gestational age - FHR: ___ bpm w/ doppler at __-__ wks gestation, can be heart w/ __ at 17-20 wks; fetal movement palpable at __ wks; balottment: during __-__ mos, fetus rises and rebounds to original position when uterus is tapped __ (may not occur w/ __) -Extremities: all pulses should be present, some __, varicosities; unpalpable/diminished r/t __ insufficiency, marked edema- ___

20, nodular, tingling, darkened, superficial, colostrum, 12th, edematous, hypertrophy, gingival, anemia diastatis recti, symphysis pubic, umbilicus, 3, ensiform, uterus 110-160, 10-12, fetoscope, 18, 4-5, oligohydraminos edema, arterial, preeclampsia

Care of PP Hemorrhage: early (primary) hemorrhage occurs in first __ hrs; delayed (secondary) occurs from 24 hrs- __ wks after birth; primary cause is ___ __; PPH is defied as blood loss greater than __ mL or drop in maternal Hct of __ or more from predelivery baseline or excessive bleeding htat requires __ __ to reverse instability; difficult to estimate blood loss b/c it is mixed w/ __ __; signs of shock don't appear until __-__ mL of blood is lost b/c of increased blood volume in pregnancy Early: -Uterine __; contributing factors include __ of uterus, prolonged labor, __ of labor, use of __, __ birth, retained __, obesity; hemorrhage may be __ and __; blood may escape vagina or collect in __ (starts to __); don't rely on VS to detect blood loss; start __ drug after __ and do a uterine massage; after delivery of placenta, palpate fundus to ensure its firmly __ (massage PRN); may need __ massage to compress from below while external hand compresses from __; __/__ will determine if they need fluid/transfusion; SL __ works well as oxytocic drug -Lacerations: predisposed if __, epidural, __ birth, forceps/vacuum, __, use of oxytocin; suspect lacerations when vag bleeding persists in presence of __ __ uterus; __ to control bleeding; __ can cause slow steady bleeding (put on __ to examine)

24, 6, uterine atony, 500, 10, blood transfusion, amnitoic fluid, 100-200 atony, overdistension, induction, oxytocin, precipitous, placenta, slow, steady, uterus, clot, oxytocic, delivery, contracted, bimanual, avoce, hgb/hct, misoprostol nuliparous, precipitous, macrosomia, firmly contracted, sutures, episiotomy, side

PP Nursing assessment VS: temp elevations only for __ h; after __ rise after birth, BP should remain __; pulse __ and returns to prepregnant levels very quickly Lungs: should be __; women who have been tx for __ labor or __ are at higher risk for __ __ Abd/Fundus: __ first, ensure __ bladder isn't causing uterine __ (assess other causes of atony, like __ block, __ uterus, __ bladder)

24, immediate, stable, slows clear, preterm, preeclampsia, pulmonary edema void, full, atony, regional, enlarged, full

Health Promotion During Pregnancy -Fetal activity monitoring: regularly assess fetal activity beginning at __ wks gestation; vigorous activity indicates fetal well being and marked __ in activity or __ of movement may indicate problem -Breast care: ___ is important to promote __, retain breast __, and prevent __ strain, particularly if breasts become __ and __; well fitting bra is necessary; clean __ off nipple w/ water (not __ b/c it is drying) -Bathing: __ d/t warm water may cause woman to feel faint when getting out of tub, may need __; __ and __ vag secretions inc during pregnancy, so __ is important - Employment: standing for more than __ h at a time increases risk for __ birth -Travel: avoid if they have hx of __ birth, bleeding, __; car: stop q __ h and walk for __ mins; generally can't fly after __ wks, drink lots of water and walk around to prevent __ and __ -Exercise: __ mins of _ exercise daily is preferred, avoid exercising in __ position after __ trimester, __ muscle strength training and more repetitions __-__x/wk (caution b/c joints are looser), modify __ b/c of dec __, ensure adequate diet, exercise is too much if they can't ___; warm up, stretch, cool down

28, dec, cessation support, comfort, shape, back, large, pendulous, colostrum, soap vasodilation, assistance, sweat, mucoid, hygeine 3, preterm preterm, prreeclampsia, 2, 10, 26, clotting, dehydration 20, moderate, supine, 1st, light, 1-2, intensity, O2, hold conversation

Determination of due date (EDC): Nagele's rule: uses __ days as length of pregnancy. EDC= first day of ___-3 mos __ 7 days; good if woman has menses q __ days, remembers __, not taking oral contraceptives; uterine __/assessment more accurate Uterine assessment: good indicator if woman comes in first __-__ wks and size is compatible w/ __; __ height is good indicator of uterine size, but less accurate __ in pregnancy; use tape measure to measure distance in __ from top of __ __ to top of __ (McDonald method); void before exam, same __ each time, sudden increase in size may mean _ or __ Assessment of fetal development: __ (fetal movement) nearing __ wks gestation (can be felt from __-__ wks); FHR detectable at __-__ wks gestation (do ___ ultrasound early, switch to __ after 10 wks); ultrasound can detect FHR at __-__ wks, fetal breathing at __-__ wks, C-R measurements at __-__ wks until 12 wks Screen for gestation DM between __-__ wks gestation; start w/ __ g 1 h test, then do __ g 3 h OGTT if results are abnormal; diabetes if over __ mg/dL

280, LMP, +, 28, LMP, measurements 10-12, LMP, fundus, late, cm, sympysis pubis, fundus, position, twins, polyhydraminos quickening, 20, 16-22, 8-12, transvaginal, transabdominal, 6-7, 10-11, 5-6, 24-28, 50, 100, 140

Precipitous labor (occurs within __ h or less): nurse uses sterile gloves to put index finger inside lower portion of __ and thumb on outer portion of perineum and gently massage to help __ tissues and prevent __ lacerations ("__ the perineum"); when crowning is visible, tell mom to __, rupture __ if they're intact, hold head in one hand to prevent it popping out rapidly (guide it __); check for __ cord (use fingers like a __ __, is more than once, clamp/cut corD), suction mouth/nose, put __ pressure so __ shoulder passes, then __ traction to deliver __ shoulder, tell mom to push to deliver rest of body, hold at level of __ to facilitate blood flow through __ __, put baby on mom w/ head lower than __ to promote drainage, when signs of __ __ Are present, tell mom to push, check firmness of __, massage as needed

3, vagina, stretch, perneal, iorning, pant, membranes, slowly, nuchal, fish hook, downward, anterior, upward, posterior, uterus, UC, body, placental separation, uterus

-Nursing care: may only see mom q __-__ wks in first few mos of pregnancy, so __ care plan or clinical path is essential to ensure __ of care; must establish __ of nursing care; home care PRN -Care of mom's family: assess __ system, __ guidance of the expectant father is important (changes that occur in mom, couple's __ response, reactions he is experiencing); refer to __ class; assess feelings of older children, as they may exhibit __ behavior -Culture: home remedies (don't __ if not harmful), nutrition (obtain diet __, discuss importance of __-__ diet w/ consideration of client's __ beliefs), alternative HCP, exercise (assure her that reaching over her __ will not harm baby; evaluate other activities and their impact on pregnancy), spirituality (encourage use of __ systems and __ aids that provide comfort for the mother), birth __ (recognize importance of birth practices that are part of family __ and honor these practices when possible) Childbearing decisions: many make a __ __, where they identify areas of __ process that are most important to them (discuss at _ visit before labor) -HCP: explain differences of __ preparation, __ level, __ style, general philosophy/characteristics of CNM, OBs, family practice doctors, __ midwives -Prenatal care services, __ setting, labor __ person (__ is specially trained to assist w/ birth and provide __ support, which includes emotional, physical, __ support; doesn't perform __ tasks, but acts as an __ for woman and family by verbalizing their wishes); siblings at birth allows them to feel more __, less __ by mom

3-4, written, continuity, priorities, support, anticipatory, sexual, parenting, regressive stop, hx, well balanced, culture, head, support, spiritual, rituals, tradition birth plan, birthing, prenatal educataion, skill, practive, lay birth, support, doula, birth, information, clinical, advocate, connected, abandoned

Nutritional care of pregnant adolescent: if pregnancy after __ yrs post menarche, they can follow __ guidelines, but if under __ yrs, they are at risk b/c of physiologic and anatomic __ and are more likely than __ adolescents to still be growing, so they need to gain more weight to produce babies of ___ size; to determine __ weight gain, add recommended weight gain for an adult pregnancy to that expected during the __ yr in which pregnancy occurs -Specific nutrient concerns: major factors in determining __ needs include whether growth has completed and __ __ level of individual; inadequate __ is major concern; inadequate __ is problematic, need adequate amts to support normal __ and __ of fetus as well of growth and maintenance of _ __ in adolescent (drink additional __ of milk/day); __ __ plays roll in cell reproduction; need adequate vits/minerals PP Nutrition -PP Nutritional status: determined by assessing new mother's __, __/__ levels, clinical signs, dietary hx; after birth, there is a weight loss of approximately __-__ lbs, additional loss is most rapid during next few __ as body adjusts to end of pregnancy, then weight starts to __; Hgb/__ levels should return to normal within __-__ wks after birth; iron supplements continued __-__ mos to rebuild stores that were depleted during pregnancy; maintain high __/__ to prevent __ -Formula feeding moms: diet should return to prepregnancy (reduce caloric intake by __); if excessive weight gain during pregnancy, refer to __, who can design weight loss reduction diets (loss of __-__ lbs/wk) -BF moms: must consume sufficient calories b/c inadequate caloric intake can reduce milk __, but milk __ remains unaffected; inc calories by __ over pregnancy requirement, or __ cals over prepregnancy requirement (2500-__ cals/day); __ is important, need same level of calcium as pregnancy

4, adult, 4, immaturity, older, equal, optimal, postmenarchal, caloric, physical activity, iron, calcium, growth, development, calcium stores, glass, FA weight, Hgb/hct, 10-12, weeks, stabilize, EPO, 2-6, 2-3, fluid, fiber, constipation 300, dietician, 1-2 quantity, quality, 200, 500, 2700, protein

Nursing care in 2nd stage -Assess BP q __-__ mins (more frequently if fetal __ or __ occur); FHR assessed q __ min in low risk, q __ mins in high risk; nurse usually stays in room during this phase; __ ready when __ bulging is noted, multipara may be ready at __-__ cm dilation; palpate contractions q __ mins until birth; promote comfort by giving __ cloths -Assisting during birth: position in __ position, elevate HOB __-__ deg (may also use __, hands/knees, ___, semi-fowler); cleanse perineum w/ soap and water to remove __ d/c; once mom delivers head, suction __ first to prevent choking, use __ technique to prevent pushing while head is out, then push again to get rest of __ out after this brief pause

5-12, deceleraitons, braducardia, 15, 5, nullipara, perneal, 7-8, 5, cool lithotomy, 30-60, squatting, LLR, bloody, mouth, panting, body

Overview of adolescent pd: -Physical changes: puberty can last for __-__ yrs; physical changes include __ __, weight changes, appearance of __ __ characteristics; menarche occurs in last 1/2 of maturational process, with avg age between ___-__ -Psychosocial development: develop sense of __, gain autonomy and __, developing intimacy in relationships, developing comfort w/ __, developing sense of __; - In early adolescence (less than __), teens still see __ in parents, but start to gain __ and conform to __ group, don't see __ of behavior; middle (__-__) experimenting, rebellious, move to __ __ thought, but still can't think of __; late (__-__) more at ease with individuality and __ __ ability; can think __ and anticipate consequences, can __ solve and make __, see themselves as in __ Factors contributing to adolescent pregnancy: -Socioeconomic/cultural factors: __ is major risk factor, as these kids see pregnancy as they only opportunity for __ __ and feel like they have little change of __; higher in __ and hispanics; intelligence and greater __ ability are positively correlated w/ delayed __, use of __, lower pregnancy rates -Psychologic factors: pregnancy desire high amount teens who were younger when they became __ __, who are in __ __ relationship, and who have greater perceived __ in their lives; family __ and poor __ __ greater risk factors, as is abuse

5-6, growth spurt, secondary sex, 12-13 identity, independence, sexuality, achievement 14, authrority, independence, peer, consequences, 15-17, formal operational, consequences, 18-19, decision making, abstractly, problem, decisions, control poverty, adult status, advancing, blacks, academic, sex, contraceptives sexually active, short term, stress, dysfunction, self esteem

PP pd lasts __ wks after birth or until body has return to near prepregnant state PP Physical adaptations: repro system -Involution of uterus: involution described rapid reduction in __ and return of uterus in prepregnant state; __ layer of decidua is cast off as __, and basal later of decidua remains in uterus to become differentiated within first __-__ hrs after birth; outermost layer becomes __ and is sloughed off in lochia; __ glands lay foundation for new __, which is completed in __ wks; placental site heals by process of __ and growth of __ tissue; w/o exfoliation, area would scar and SA for future __ would be reduced; __ promote self __ of uterus; uterine cells __ -Changes in fundal position: immediately following birth of __, uterus contracts to size of __, which firmly compresses uterine __ __; within __-__ hrs, fundus of uterus rises to level of __ b/c of blood and clots that remain in __; __ fundus above umbilicus r/t __ bleeding; when fundus is high and not midline, suspect __ __; top of fundus remains at umbilicus for __ day, __ finger below umbilicus for __ day, __ fingers below on 3rd day; descends one finger per day until it descents into pelvis on __ day -Cervix is __, formless, may appear __ or bruised

6. size, spongy, lochia, 48-72, necrotic, endometrial, endometrium, 3, exfoliation, endometrial, implantation, macrophages, digestion, atrophy grapefruit, blood vessels, 6-12, umbilicus, uterus, boggy, excess, bladder distension, 1/2, 1, 1st, 3, 10 flabby, lopsided

Factors influencing nutrition -Discomforts of pregnancy: __ function can be altered, resulting in __, heartburn, __ -Complementary/alternative therapies: pregnancy consumer should take caution of herbal, __, __ therapies -Artificial sweeteners: sweeteners classified as __ __ ____ __ are acceptable for use during pregnancy and include __, splenda, __ , sweet n low -Energy drinks: drink __ in pregnancy and include the drink's __ content when calculating daily __ intake in order to stay within recommended levels -Foodborne illnesses: pregnant women should avoid eating/tasting food that may contain __ __; to prevent listeria infections, maintain fridge at __ deg G, refrigerate prepared foods/leftovers within __ hrs of prep, do not eat __ __ and lunch meats unless they are reheated until they're __ hot; avoid __ cheeses unless indicated that they're made with __ m ilk; no refrigerated __ spreads or __ milk; avoid refrigerated __ seafood -Mercury in fish: encourage them to eat __-__ oz of fish that are low in mercury per week; includes __ tuna, shrimp, __ , __ - LI: results from inadequate __; leads to __ distension, discomfort, N/V, __ stools, cramps -Eating disorders: __ leads to distorted body image, as intake is very __; bulimia is __ and __, can produce many of the same complications as __ __ -Pica: persistent eating of substances that aren't __; may have __ deficiencies, __ deficiency i s most common; sucking hard __ or __ candies can dec craving

GI, NV, constipation botanical, alternative generally recognized as safe, equal, truvia cautiously, caffeine, caffeine raw eggs, 40, 2, hot dogs, steaming, soft, pasteurized, meat, unpasteurized, smoked 8-12, light, salmon, catfish lactase, abd, loose anorexia, restrictive, binging, purging, hyperemesis gravidarum edible, nutrient, iron, lemon, mint

Client profile (1st prenatal visit) -Current pregnancy: first day of __, presence of cramping/__/__ since LMP, reports of discomfort -Past pregnancies: # of pregnancies, __; about past births, neonatal status of previous children; __ of children; blood type/rh, __ classes -Gynecologic hx: date of last __ __, previous infections, previous surgery, age at __, __ hx -Current med hc: weight, general health, current meds, past/present use of __, __, tobacco; drug allergies; potential __ insults to this pregnancy; presence of __ conditions; record of __ -PMH: childhood diseases, __ disorders, surgeries -Fam hx: med hx, hx of __ diseases/deformities, occurrence of ___ and cause -Genetic: __ defects, __ pregnancy loss, __, DS, genetic disorders -Religion: any practices important to mom's __ or __ of child - Occupation: __ demands, exposure to __ -Birth father hx: age, health problems, __ __/rh factor, presence of __ condition; job, drugs, __ -Personal hx: age, __, education, housing, economic, __ of kid, __ health problems, support

LMP, bleeding, spotting, abortions, death, prenatal pap smear, menarche, contraceptive drugs, alcohol, teratogenic, chronic, immunizations blood congenital, c section birth, recurrent, stillbirth, well being, care physical, chemicals, blood type, genetic, education relationship, acceptance, mental

First trimester combined screening: include __ __ test and __ screening for pregnancy associated __ __ __ and free __ __ to determine if fetus is at risk for trimsomies __, __ , __; NTT can be done between __-__ wks, measurements over __ mm indicate r/f trisomies Cell free fetal DNA testing: maternal screening blood test that can test for trisomies __,__,__ can detect __ defects when circulating in mother's __ Umbilical velocimetry: measure __ __ changes that occur in maternal and fetal circulation to assess __ function; ultrasound beam is directed at the umbilical __, which is reflected off __ moving in vessels to create a waveform Fetal acoustic and vibroacoustic stimulation tests: device placed on mom's abd over fetal __; vibration//sound intended to induce __ and associated __ of FHR

NT, serum, plasma protein, A, beta hcg, 13, 18, 21, 11-12, 3, 13,18, 21, DNA, serums blood flow, placental, artery, RBCs head, movement, accelerations

PPTs: -__ most common cause of PP death -Define beneficence, nonmaleficence, autonomy, justice -Sentinel event- __ __, need to be reported -Best site for implantation is __ uterus b/c it has best __ __; uterus is thick, placenta can't __ that deeply, which is good for birth (limits __ __) -Infarcts (__) on placenta means problem w/ blood flow -If any __ __ __ are still open at birth, there will be a murmur -Only 2 umbilical vessels indicate __ or __ problem -Polyhydraminos may be r/t __ problem, oligohydraminos r/t __ problem -Folate needed for adequate __ __, fetal/placental development, cell __; prevents __ (SB and __); __ mg/day to reduce risk; green leafy vegetables, nuts, __ fruit, egg, meat, bread -__ if too little weight gain, __/__ if too much weight gain -Exercise: encourage __

PPH baby death, upper, blood flow, implant, blood loss white, fetal heart structures, kidney, heart swallowing, kdiney cell growth, division, NTD, ancephaly, 4, citrus IUGR, macrosomia, cephalopelvic yoga

Nursing: -Tell pt to come to hospital if __ __ __, regular/frequent contractions (nulliparas __ mins apart for __ mins; multiparas __ -__ mins apart for __ mins), vag bleeding, dec fetal __ -Once at the hospital, give woman quick tour, explain __ equipment, put in __ __ or __ __ position -Begin nursing intrapartum assessment by auscultating __ __ __; determine woman's ___; assess contraction frequency, __, ___; do __ exam (repeat immediately if signs of __ labor exist- __ contractions, urge to __ __); if there are signs of excessive __ or painless __ during third trimester, suspect __ __ and avoid vag exam -After obtaining admission data, get __ __ __ __ urine specimen; use __ for protein, ketone, gluose; __ of __ or more may be sign of impending __; __ common b/c of inc GFR and dec __ of glucose, can also be r/t _ _; lab tests: hgb/hct to determine __ __ capability of blood and to determine woman's ability to withstand __ __ at birth; elevated __ r/t __ or edema, low __ indicates anemia

ROM, 5, 60, 6-8, 1, movement monitoring, side lying, semi fowlers, FHR, vitals, intensity, duration, vag, advanced, frequent, bear down, bleeding, bleeding, placenta previa, clean catch mid stream, distick, proteinuria, 1, preeclampsia, glycosuria, reabsorption, gestational diabetes, O2 carrying, blood loww, hxt, dehydration, hgb anemia

Relief of perineal discomfort: -peri care: cleanse __ each elimination, prevents __, promotes __; can use peri bottle w/ __ tap water; change pad after __ and __; cleanse area w/ __ and __ at least 1x/day in addition to peri bottle; change pad __x/day minimum -Ice: __ mins on, __ mins off for first 24 hr -Sitz: warm provides __, decreases __, promotes __ to tissues, which promotes __ and reduces incidence of __; may be ordered __x/day; remain in bath for __ mins; may order cool bath to reduce __ (__ add ice) -Topicals: __ is a topical anesthetic spray that can relieve __ discomfort, apply after __ bath; __ __ can relieve discomfort and edema (__) Relief of afterpains: r/t intermittent __, common in multiparous woman b/c their uterus might not maintain a __ state; tell them to lie __ w/ pillow over abd, causing uterus to achieve constant __; can ambulate or give analgesic __ mins before BF -Early __ prevents constipation and __; assist first few times OOB -PP Diaphoresis: change gowns/linens, give __ shower, give fluids

after, infection, comfort, warm, pee/poop, sopa, water, 4 20, 20 comfort, pain, perfusion, healing, edema, 3, 20, edema, gradually dermoplast, perineal, sitz, witch hazel, tucks contractions, contracted, prone, contraction, 30 ambulation, thrombophelbitis cool

-Rubin's 4 major psychosocial tasks? - __ __ is created by fetal liver, high levels could indicates __, not accurate if __ aren't accurate; f/u w/ amnio -AFP, __, __, diametic inhibin A to test for trisomy __, 21, and NTDs -CVS: blood from __ space; CI w/ __ infections; if mom is Rh- she will need __ shot after -Amnio- 15-20 wks when mom has adequate __ __; monitor mom for cramping for __ mins after, tell her to rest for rest of day -First prenatal visit: __ __ for cervical cancer and __ of cervix, BP, __ culture; labs: blood type, CBC, urinalysis; test for ___, hep __ titer, toxoplasmosis, syphylis (__,__) -Viability is __-__ wks (more likely to survive after 24 wks b/c of __ production); preterm is __-__ wks -4 wks: __ __ close, 8-12 wks: __ detected by doppler, __ can be determined; 16 wks: fetus __ amniotic fluid and eliminates __; 21-24 wks: lungs produce __ -If mom doesn't have rhogam in first pregnancy, she will make __ against baby, harming future pregnancies -__-__ wks: get culture for strep b, if positive, give IV __ during labor to prevent transmission to baby (can cause __)

alpha fetoprotein, NTD, dates hcg, estriol, 18, intervilli, vag, rhogam amniotic fluid, 60 pap smear, infection, urine, HIV, B, RPR, VDRL 22-26, surfactant, 20-37 neural tibes, heartbeat, sex, swallows, urine, surfactant antibodies, 35-37, PCN, sepsis

-Baby should have normal baseline, __ variability, __ NST -Variability: absent, minimal (less than or equal to __ bpm), moderate (__-__ bpm), marked (more than __ bpm) -Early decelerations: __ onset; greater than or equal to _ seconds from onset to nadir, which is simultaneous w/ __ of contraction; cause: __ __; good sign, no tx required - Late: __ onset greater than or equal to __ s from onset to nadir; delayed in timing, nadir __ peak of contraction; turn __ off, turn mom on __, increase __, get __ via face mask, CALL DOC -Variable: __ onset, less than __ s from onset to nadir, lasting greater than or eqaul to __ s, but less than __ mins, depth greater than or equal to __ bpm; turn mom on __ (she can __ if these go away) -VEAL CHOP -Low apgar- do __ __ (less than __ indicates...) -Categories of FHR monitoring patterns: cat 1: normal, no interventions, 2- __ of fetal stimulation when you __ them, 3- no __, really bad, need stat __ birth

moderate, reactive 5, 6-25, 25 gradual, 30, peak, head compression gradual, 30, after, pitocin, side, IV, 8-10 lpm sudden, 30, 30, 2, 15, get up, variable, early, accelerations, late; cord compression, head compression, ok, placenta perfusino problems cord blood, 7/25, hypoxia, acidosis absence, tickle, variability, c,

Epidural blocks: injection of __ into epidural space to provide pain relief throughout labor; accessed through __ area; can be given as soon as __ is established; r/f that increase observation include maternal __, asthma, OSA, __ problems, SC injuries -Advantages: relieves __, woman is fully awake; few adverse __ effects when compared with IV __ or general __; allows woman to rest and regain __ before she needs to push again; continuous epidural allows different blocking for each __ of labor; opioids are used with epidural blocks for labor (fentanyl+low dose of __ anesthesia) -Disadvantages: can cause maternal __ (give IV __, put mom on side), labor may be __, pushing efforts may be less __; bladder __ r/t dec __ -CI: maternal problems w/ blood __, inc __, hypovolemic shock -Nursing: tell them to __ first, continuous fetal __; __ g w/ fluids (__-__ prior to epidural); can give epidural either side lying or sitting; assess VS frequently, assess ability to lift __ and level of __ q 30 mins; during second phase, woman might need help __; make sure to avoid ___ (give __ if hypotension doesn't reverse in 1-2 mins); epidural can cause __; headache is normal; test sensation, __ ability, __ hypotension prior to letting them stand for the first time

anesthetic, lumbar, active labor, obesity, cardiac pain, fetal, analgesia, anesthesia, strength, stages, local hypotension, fluid, prolonged, effective, distension, sensation coagulation, ICP, void, monitoriting, 18, 500-1000, legs, sensation, pushing, hypotension, ephedrine, feber, motor, orthostatic

Nursing care during 1st stage of labor -Culture: __ women are stoic about pain; mexicans say __ __ __, which promotes __, slow breaths and alleviates __; ask muslim __ if something is ok for the __; vietnamese women view pregnancy as __, so they drink __ things, but drink hot things __ __ -Latent phase: assess temp q __ h, monitor BP/TPR q __ h, palpate contractions q __ mins to determine duration, __, frequency; offer fluid in form of __ _ frequently, unless they may need __ __ -Active phase: palpate contractions q __-__ mins; vag exams to assess cervical __ and __ and fetal __ __; monitor BP/TPR q h, FHR q __ if low risk (q __ mins if higher risk); encourage __ __ over supine; wash perineum w/ __, __ water; if membranes rupture during this phase, immediately assess __ __ __; fetal stress leads to __ and __ sphincter relaxation, releasing meconium - Transition: palpate contractions q __ mins; vag exams more frequent in this stage b/c this stage is accompanied by __ change; take BP/TPR q __ mins, auscultate FHR q __-__ mins; encourage rest in between ___; tell mom not to push until she is __ cm dilated to prevent cervical __ -General comfort: encourage mom to walk as long as there are no CIs, like _ __ or ROM w/ no __; walking can promote __ and comfort; if no walking, at least __ __; back rubs and frequent __ __; empty bladder q __-__ h; begin breathing technique at __ of each contraction; firm pressure on __ back or __ area may relieve back pain associated w/ labor -Breathing: can increase woman's __ __, permit relaxation; __ levels, switch to new level w/ __ breathing (inhale through nose, exhale through _ lips); first pattern is slow, __ breathing (only chest moves, slow inhale through __, exhale through __ lips); 2nd is __ breathing, start w/ __ breath and end it with pushing out __ breath, then inhale/exhale __ breaths q __ s; 3rd: __ blow, similar to 2nd, but breathing is punctuated q few breaths by forceful __ through __ lips

asian, ay yie yie, deep pain, husband, wife, hot, cold, PP 4, 1, 30, intensity, ice chips, ce section 15-20, dilation, effacement, station position, 30, 15, side lying, soap, warm, FHR, anal, intestinal, 15, rapid, 30, 15-30, contractions, 10, edema vag bleeding, engagement, descent, sit up, position frequently, 1-2, beginning, lower, sacral pain threshold, 3, pursed, deep, nose, pursed, shallow, cleaning, short, 4, 5, pant, exhalation, pursed

Definitions Antepartum Intrapartum Gestation Abortion Stillbirth Late preterm, Early term, full term, late term, post term Preterm vs postterm labor nulligravida, primigravida, multigravida nullipara, primipara, multipara gravida vs para G/P refers to __, not to __ (multiples count as __) T: early, full, late term births (# of kids born at __ 0/7 wks +) P: # of __ births, whether living or stillborn A: # of pregnancies ending in either __ or __ abortions L: # of currently __ children to which the woman has given birth

between conception and onset of labor onset of true labor-->delivery of placenta # of wks since 1st day of LMP birth before end of 20 wks gestation born dead after 20 wks 34 0/7-35 6/7 37 0/7-38 6/7 39 0/7-41 6/7 after 42 wks labor after 20 wks, before 36 wks vs labor after 42 wks never been pregnany, first pregnancy, multiple pregnancies no births at more than 20 wks gestation, 1 birth at more than 20 wks gestation, multiple births at more than 20 wks gestation any pregnancy, including current pregnancy; any birth after 20 wks gestation regardless of alive or dead pregnancies, children, 1 37 preterm spontaneous, therapetuci living

Biophysical profile: assesses fetal __ movement, fetal movement of __/__, fetal __, amniotic fluid __, __ FHR w/ activity; scored on scale of 0-__ Contraction stress test: evaluating __ function of __ to identify risk of intrauterine suffocation by observing __ in relation to the stress of __ contractions; during contractions, intrauterine __ increases, blood flow to __ is reduced, thus decreasing O2 __ to fetus (healthy fetus should __ this and maintain __ HR); may need trial of labor by giving __ for 2 hrs, see if baby does well (if too many decels, c-section is indicated) NST: based on understanding that when the fetus has __ oxygen and intact __, there are __ of FHR w/ fetal __; nonreactive NST is consistent in identifying ___ fetuses; can be done in reclining/___ position, not supine as it is associated with reduced fetal __; belt hold __ to detect uterine/fetal movement, while other belt hold the ultrasound __ to detect ___; reactive test shows at least __ accelerations of FHR w/ fetal __ of __ bpm, lasting __s or longer, over __ mins; nonreactive: criteria not met

breathing, body/limbs, volume, accelerations, 10 respiratory, placenta, FHR, uterine, pressure, placenta, transport, tolerate, stable, pitocin, adequate, CNS, accelerations, movement, at risk, side lying, tocodunamometer, transducer, FHR, 15, movements, 15, 20

Maternal systemic response to labor -Cardiovascular system: __/pain stress cardiovascular system; with each contraction, __-__ mL of blood is forced back into maternal circulation, resulting in increased __ __, which increases BP -Respiratory: __ can lead to respiratory __; as they push, mild respiratory __ occurs; A/B levels return to normal levels __ hrs after birth -GI: motility/__/emptying reduced during labor -IS: WBCs increase to __-__ during labor r/t inc __ resulting from physiologic response to stress, making it difficult to identify __; dec __ b/c of high energy demands Fetal response to labor: -FHR __ can occur w/ inc __ as head pushes against cervix -A/B status in labor: blood flow is __ to fetus at __ of each contraction, leading to slow __ in pH; fetal pH decreases more __ when mom holds breath; O2 sats __ -Hemodynamic changes: exchange of __ and __ in fetal __ depends on fetal BP; blood reserve in __ helps fetus remain unaffected though periods of low __ during labor

contractions, 300-500, CO hyperventilation, alkalosis, acidosis, 24 abs 25000-30000, neutrophils, infection, BGL decelerations, ICP dec, peak, decrease, rapidly, decrease nutrients, gases, caps, placenta, O2

Care during induction: stimulation of __ prior to spontaneous onset of labor; indicated with _ _, preeclampsia, premature __ _ _, postterm gestation, ___, IUGR; CI w/ __ __, active __ __, UC prolapse, nonreassuring fetal status -Labor readiness: __ wks considered term; don't elect for __ earlier than this, use __ scoring to determine __ readiness (__ PRN prior to induction) -Methods of inducing labor: __ membranes (insert gloved finger, rotate __ 2x, releases __ that stimulates contractions), mechanical __ w/ intracervical dilation (can use __ in cervix and inflate balloon, but difficult to __ and __), oxytocin infusion (can induce labor and can enhance __ contractions; goal is to achieve stable contractions q __-__ mins that last __-__ s, uterus should relax to baseline resting __ between contractions, progress measured by changes in __/dilation of cervix and station of __ part) -Assess FHR, presence of decelerations/accelerations q __ mins; record client activities and admin of __; look for more __ contractions that occur more than q __ mins and last longer than __ s; prior to admin, nursing must obtain maternal __ __ and a __-__ min electronic fetal monitor reading demonstrating good FHR, __ NST, and contraction status before starting induction

contractions, DM, ROM, oligohydraminos, placenta previa, genital herpes, 39, bishop, cervical, ripening stipping, 360, prostaglandins, dilation, foley, place, maintain, inefffectice, 2-3, 40-60, tone, effacement, presenting 15, analgesics, frequnt, 2, 60, VS, 20-30, reactive

3rd stage of labor: uterus __ after baby is born, decreasing capability of __ to remain attached, leading to __, resulting in __; signs of separation appear __ mins after birth and include __ shaped uterus, rise of __, sudden gush of blood, further protrusion of __ __; can bear down to aid in expulsion, may need to gently pull cord; considered __ if more than __ mins passed since birth 4th stage: __-__ hrs after birth in which physiological readjustment of mom's body begins; blood is __, resulting in temporary __ and __; bladder is often __ b/c of birth trauma, leading to urinary __

contractions, placenta, separation, bleeding, 5, globular, fundus, UC, retained, 30 1-4, redistributed, hypotension, tachycardia, hypotonic, retention

UTI: increased risk r/t normal PP __, inc bladder __, dec bladder __, possible inhibited __ control of bladder; overdistension is r/t __ or __; after effects of regional anesthesia have worn off, if woman can't void, PP urinary retention is hihgly indicative of ___; tx w/ _ __ if overdistension recurs, and an __ __ may be needed for __ hrs; apply __ packs after delivery to prevent swelling Cystitis (__ UTI): retention of __ urine, bacteria introduced at time of __, and bladder __ by birth combine to provide environment for development of __; generally infection ascends from __ to __ and then to __ b/c of vesicoureteral reflux - diagnose w/ __ __ __ urine sample (no __), bacterial concentration more than ___ indicates infection - tx w/ __, sulfonamide, __; can give __ for analgesic; encourage woman to void q __-__ hrs - symptoms of cystitis appear ___-__ days after birth and can include frequency, __, dysuria, __; - when it progresses to pyelonephrisis, symptoms include __, high fever, __ pain, NV, __ tenderness

diuresis, capacity, sensitivity, neural, trauma, anesthesia, cystitis, straight cath, indwelling cath, 24, ice lower, residual, cath, trauma, cystitis, uretha, bladder, kidneys clean cath midstream, lochia, 100 000, bactrim, ampicillin, phenazopyridium, 2-4 2-3, burning, nocturia chills, flank, CVA

Endocrine -Thyroid: __ b/c of inc __ and hyperplasia of glandular tissue -Pituitary: produces __ for ovum growth, __ for ovulation, prolactin, oxytocin promotes uterine __ and stimulates milk __ from breasts (__ reflex) Adrenal: circulating __ increases in response to inc __ levels; inc levels of __ to retain sodium as __ can deplete sodium Pancreas: inc __ needs Hormones: -hCG: stimulates __ and __ production to maintain pregnancy until __ is developed enough to assume that function -Estrogen: stimulates __ development to provide suitable environment for __, develops __ system of breasts in preparation for __ -Progesterone: maintains __, inhibits spontaneous uterine __, thus preventing __

enlarges, vascularity FSH, LH, contractility, ejection, letdown cortisol, estrogen, aldosterone, progesterone, insulin progesterone, estrogen, placenta, uterine, fetus, ductal, lactation endometrium, contractility, miscarriage

Cardiovascular: BV increase in beginning of __ trimester, increases rapidly until __-__ wks, then levels off until birth; during pregnancy, blood flow increases to organ systems w/ inc ___; CO increases; pulse may increase by __-__ bpm at term, BP dec slightly, reaching lower point during __ trimester; may get __ edema, hemorrhoids, varicosities r/t obstructed blood __; total RVC volume increases to transport additional __, but ___ volume increases the most, leading to __ anemia of pregnancy; inc RBCs increases need for iron (___ mg daily), can be found in __ supplements; WBCs increase, range __-__, can reach __ during labor/early PP; plasma __ and __ inc during pregnancy Skin/Hair: __ __, facial __ (mask of pregnancy, darkening of skin over __ and around __), sweat glands __, striae, vascular spider __-small, bright red elevations of skin radiating from __ body Musculoskeletal: no changes in __; joints of __ relax, resulting in __ gait; __ __ r/t enlarging uterus on abd muscles Metabolism: most metabolic functions __ b/c of inc demands of growing fetus and its support system -Weight gain: normal weight (BMI: _)- __-__ lbs, overweight (BMI: __) __-__ lbs, obese (BMI __) __-__ lbs, underweight (BMI:__) __-__ lbs; woman of normal weight would gain __-__ lbs during first trimester, followed by avg gain of __ lb/wk in last 2 trimesters; if underweight gain more, if overweight, gain __ lb/week, obese gain __ lb/wk -Water metabolism: inc water __ r/t hormones, lower serum __; extra water needed -Nutrient metabolism: fetus makes its greatest __ and __ demands during 2nd half of pregnancy, __ in weight during last __-__ wks; protein must be stored during pregnancy to maintain constant level in __ __; carbs need increase

first, 30-34, workload, 10-15, second, dependent, return, o2, plasma, physiologic, 27, prenatal, 5000-12000, 25000, fibringen, fibrin linea nigra, chloasma, forehead, eyes, hyperactive, nevi, ventral teeth, pelvis, waddling, diastasis recti increase, 18.5-24.9, 25-35, 25-29.9, 15-25, over 30, 11-20, less than 18.5 ,28-40, 1-4, 1, .6, .5 retention, protein, protein, fat, doubling, 6-8, BM

Promotion of effective parent learning: first assess learning needs through __, sensitivity to __ cues, and tactfully __ questions; time lessons __; __ materials are helpful to consult at __; evaluate learning (can do __ __ calls at home); review signs of ___ Promotin of family wellness: family centered care is focused on keeping __ and __ together as much as the mother desired, which provides inc opportunities for parent-child __ b/c of "__-__"; conducive to __-__ feeding schedule -Siblings: seeing mom reassures child that mom is __ and still __ them, allows them to become __ w/ new baby; can let siblings in NICU if you take their __ first; if small children are waiting at home, have __ carry baby in so mom can __ other kids; bring kids a __ to help them relate to parents -Parent-NB attachment: determine parenting __ and adapt lessons to this __, provide __ for family to get acquainted, use __ __, help parent identify baby's ___

observing, nonverbal, phrased, appropriately, written home, follow up, PPD mom and baby, interaction, rooming in, hunger, demand well, loves, acquanted, temp, dad, hug, doll style, style, privacy, anticipatrory guidance, needs

PP Adaptations -Neuro/immunologic changes: __ result from __ shifts in first week after birth, leakage of __ into __ space during spinal anesthesia, HTN, __ imbalance, preeclampsia, stress -Weight loss: initial weight loss of __-__ lbs r/t birth; diuresis loses additional __ lbs; most return to prepregnant weight in __ mos -PP chill: mothers experience intense __ that resemble __ from a chill immediately after birth; cover her with __, drink warm beverage -Afterpains: common in multiparas __-__ days after birth r/t uterine __/loss of uterine __; __ from breastfeeding increases pain PP Psychological adaptations -Taking in: occurs right after birth, mom is preoccupied w/ __ needs; taking hold: __-__ days PP, ready to resume control of her __, her __, her __ in general -Becoming mom: maternal role __ is process by which woman learns mothering __ and becomes comfortable w/ her __ as a mom (__-__ mos after birth) -PP Blues: transient pd of __that occurs during first few __ PP; mood swing, anger, __, anorexia, difficulty __, feeling of being __ __; r/t changing __ levels; diagnose w/ Pregnancy __ __ __ __ survey; usually resolves in __-__ days, but if they persist, evaluate for PP __

headahces, fluid, CSF, epidural, f/e 10-12, 5, 2 tremors, shivering, blanket 2-3, distension, tone, oxytocin her, 2-3, body, baby, life attainment, behaviors, role, 3-10 depression, days, weepiness, sleeping, let down, hormone, Risk Assessment Monitoring System, 10-14, depression

Initial Prenatal Assessment: focuses on woman __ by considering __, cultural, and __ factors that influence her health; before exam, woman should provide a __ urine specimen for screening; when bladder is __, examiner can palpate __ organs more easily -Vitals: BP: __ normal, emergency if over ___ (preeclampsia develops after __ wks); HR: can increase __ bpm in prepregnancy; resp: 12-20, __ and __ breathing predominant; temp ___-___, elevated with __; weight: sudden weight gain may indicate __ - Skin: pallor (__), bronze/yellow (__ disease), blue/red/mottled/__ nailbeds indicate __; do __, bilirubin, __; severe edema r/t ___ - Thyroid: __, __ lobes palpable on both sides of __ is normal, slight __ by __ month of pregnancy; __ is enlargement and tenderness; listen for __, assess __; question __ intake - lungs: should present __; all abnormalities associated with typical lung problems - heart: may have __, short __ murmurs that increase in held __ are normal d/t inc volume

holistically, physical, psuchosocial, clean, empty, pelvic 120/80, 135/85, tachypnea, thoracic, 97-99.6, infection, preeclampsia anemia, hepatic, dusky, anemia, CBC, BUN, preexlampsia soft, smooth, trachea, hyperplasia, 3rd, hyperthyroidism, bruits, TSH, iodine normally palpitations, systolic, expiration

PP Adaptations GI: __ common following birth, often quite __ and will drink lots of fluids, which replaces those lost during __; __ bowels after birth, holding poop in makes problem __; give fluids after __ birth and __ when BS return Urinary tract: PP woman has inc __ capacity, swelling, bruising of __ around urethra, dec __ to fluid pressure, dec sensation of __ __; anesthetic blocks inhibit __ functioning of bladder, urine output __ during early PP pd (first day) because of __ diuresis (kidneys must eliminate estimated __-__ mL of ECF w/ normal pregnancy, causing rapid __ of bladder); full bladder impairs __, leading to hemorrhage VS: after __ h, mom should be afebrile (increases after birth r/t __ and __, can go between __-__ when milk comes in); most women experience risk in BP, but returns to normal after a few days, bradycardia in first __-__ days PP Blood values: should return to normal by end of ___ pd; pregnancy associated activation of __ __ may continue for variable amounts of time, creating r/f __ (dec w/ early __); __ during labor and immediate PP pd (WBCs __-__), will return to normal by end of first week; blood loss in first __ hrs accounts for __ of RBC gained throughout pregnancy; __-__% drop in Hct represents blood loss of 500 ml; platelets dec __-__ days PP then return to normal by day __; diuresis in first __-__ days

hunger, thirst, labor, sluggish, worse, c, solids bladder, tissue, sensitivity, bladder filling, neural, increase, peurperal, 2000-3000, filling, contractions 24, exhaustion, dehydration, 100-102, 6-10 PP, clotting factors, clots, ambulation, leukopcytosis, 25000-30000, 24, 1/2 2-3, 3-4, 6, 2-5

-RH alloimmunization: prevention: give RH __ __ if mom is negative and has no __ __, at 28 wks gestation, baby daddy is __ or unknown, after each __ and within __ hrs PP, amniocentesis and placenta __, invasive procedures that may cause bleeding - Check up q __ wks until 28 wks, q __ wks until 26 wks, q wk after 36 wks -1st trimester DS risk assessment: NT, __, free __ -2nd trimester: ultrasound at __ wks, maternal serum __ for __; triple screen (__, estriol, Hcg) for __; quad screen (__, estriol, Hcg, __ __) for DS and trisomy __; if abnormal, diagnose by __ -22-34- cm=wks +/- __-__ wks -__ edema fine, __ edema problem, elevate legs after work -Round ligament pain, rest on __, use __ -Pelvic exams after __ wks -Ongoing assessments: weight, __ __, __ __, fetal growth, developmental tasks, assess for danger signs -Danger signs: visual disturbances (__ of __, scotoma, blurred), severe/persistent __, __ pain, dec fetal movement, edema of __/hands, muscular irritability or convulsions, signs of __ labor; if they have contractions for more than __ mins preterm, call doc -GDM: __-__ wks, 1 hr glucosa (__ g), if higher than __, then do 3 hr glucola -Call doc if __, which can stimulate labor

immune globulin, antibody titer, rh+, abortion, 72, previa, 4, 2, PAAP-A, beta hcg 18, AFP NTD, AFP, DS, AFP, inhibin A, 18, amnio 2-3 pedal, leg side, heat 38 BP, urine culture flashes light, headache, face, premature, 60 24-28, 50, 140, UTI

Critical factors in labor Relationship between passage and fetus: -Engagement of fetal __ part; occurs when __ part reaches or passes through pelvic __ and is at level of __ spines (__) -Station: relationship of __ part to imaginary line drawn between __ __ of maternal pelvis (_-__), positive indicates it passed __ __; __5 is inlet, __4 is outlet -Fetal position (page 327) Physiologic forces of labor: -Primary force: __ __ contractions, which cause the complete__ and __ of cervix; secondary force is use of __ muscles to push -Dilation: __ opens in first stage of labor in response to __ -Contractions have 3 phases: __ (building of contraction), __ (peak of contraction), __ (letting up of contraction); frequency (timing), duration, intensity (determine by how much the __ wall can be indented) Psychosocial considerations: __, culture, previous __, support

presenting, inlet, ischial, 0 presenting, ischial, spines, -5-+5, pelvic spine, -, + uterine, muscle, dilation, effacement, abd cervix, contractions increment, acme, decrement, uterine prepartion, experiences

Continuous epidural infusion: can be given w/ __ __ (reduces use of bolus, which may provide __ pain control, but can cause __ pain, sedation, N/V, __; some women will experience __ __ where the pain is present, tx by changing __ and adding additional meds if needed; assess VS q __-__ mins Spinal block: __ anesthetic injected into __ __ in spinal canal to provide anesthesia for __ __ and occasionally for __ birth; immediate onset of __, need for smaller med __, favored when c birth is __ needed; high incidence of __ (can lead to alterations in __) r/t blocking of __ nerve fibers; same nursing interventions as __; block may reduce ability to __; woman should stay in bed for __-__ hrs after block, might not regain __ and control of bladder for __-__ hrs, may need cath Pudendal block: administered via __ method; intercepts signals to __ nerve, which provides __ anesthesia for latter part of __ stage of labor, second stage, birth, __ repair (doesn't help w/ __ pain); doesn't cause __ or FHR Local infiltration anesthesia: injecting anesthetics into __, subcutaneous, and __ area of perineum; used for __ repair General anesthesia: needed for __ __; leads to difficulty in __, inc blood loss r/t __ relaxation; fetal __; before induction, place wedge under womans __ hip to displace uterus to prevent supine hypotension

infusion pump, intermittent, breakthrough, hypotension, hot spots, position, 15-20 local, spinal fluid, c section, vag, anesthesia, volume, rapidly, hypotension, FHR, sympathetic, epidural, push, 6-12, sensation, 8-12 transvaginal, pudendal, local, first, episiotomy, contraction, hypotension intracutaneous, IM, episiotomy c birth, intubation, uterine, depression, right

Premonitory signs of labor -__: effect that occurs when fetus begins to settle into pelvic __ (engagement); w/ fetal descent, the uterus moves __, breathing gets easier -BH: __, intermittent contractions; pain focused in __ and __; presence of these contractions indicate ___ labor, which can be exhausting and __ -Cervical changes: __ of cervix (__) r/t breakdown of __ fibers by enzymes as term approaches -Bloody show: w/ __ and __ of cervix, __ __ is expelled, resulting in small amount of __ loss from exposed cervical __, resulting in pink tinged secretions; indicates labor will begin in __-__ hrs -ROM: occurs when __ __ ruptures, resulting in expulsion of __ __; indicates birth within __ h; if this occurs before __, cord can be __; ROM increases r/f __; go to ER -Sudden burst of energy: __-__ hrs before labor

lightening, inlet, downward irregular, abd, groin, false, uncomfortable softening, ripening, collagen softening, effacement, mucous plug, blood, caps, 24-48 amniotic sac, amniotic fluid, 24, engagement, prolapsed, infection 24-48

PP Exam (BUBBLEHE): measure __ on ongoing basis; continuous assessment during first __ h after birth b/c hemorrhage occurs with first __ hrs and is related to uterine __ -Breasts: n- soft, __, __ nipples, colostrum present; a- flat/__, red, tender, __ -Uterus: n-fundus __, midline, position depends on time since __; a- uterus __, soft, shifted to __, positioned __ umbilicus, excessive __ -Bowels: n- abd soft, __, normal ___, BM w/ no difficulty; a- distended, __, no __ -Bladder- n- nondistended, __ on exam, adequate voiding; a- distended, __ urine -Lochia: n- immediate after birth until __ days, serosa __-__ days, alba after that, __ odor; a- heavy, clotting, __ smell -Episiotomy: n- mild __, intact; a- excessive __, bruising, hematoma, d/c; apply ice for __ mins on/__ mis off for first __ hr, sitz bath __ 24 hr -Hemorrhoids: n- small, __; a- full, __, inflammed; tx w/ __ __, __ baths, fluid/fiber -Emotions: n- __, some anxiety; a- lack of __, unusual behaviors, depression

lochia, 24, 24, atony filling, erect, inverted, cracking firm, birth, boggy, R, above, tenderness nontender, BS, tender, gas nonpalpable, retaining 3, 3-10, earthy, foul edema, edema, 20, 20, 24, after nontender, tender, witch hazel, sitz attached, attachment

Labia majora: may be __ if previous pregnancies; vagina pink or __ __, d/c odorless; cervix (__-__ wks: enlargement in __ diameter; __-__ wks: Goodell's/Chadwick's sign; 8-12 wks: vagina/cervix are __/__ in color (Chadwick's)); uterus should e __ shaped, mobile, smooth (fixed if __); ovaries are small, __ shaped, __ -Anus/rectum: cervix may be felt through __ wall; warts indicate __ - Hgb: less than __ indicates anemia, hct less than __ indicates anemia, RBC __-__, WBC __-__, platelets should be above ___ (low indicates thrombocytopenia); NT or __ markers for __; urine should be normal color and normal __, ph __-__, only small amount of __ acceptable, but negative for __; if positive for hepB, give baby __ and __ right after birth Assess q __ wks for first 28 wks, q __ wks until __ wks, then every week until child birth Impending labor if uterine contractions increase in __, duration, __, bloody show, expulsion of __ __, ROM

loose, dark pink, 1-4, anteroposterior, 4-8, bluish/violet, pear, PID, walnut, nontender rectal, HPV 11, 33, 4.2-5.4, 5000-12000, 150 000, serum, aneuploidy, SG, 4/6-8, glucose, proteins, IVIG, hep b vaccine frequency, intensity, mucous plug

Fetal circulatory system: most blood supply bypasses fetal __ b/c they don't carry out resp __ exchange; placenta assumes function of __ by supplying O2 and allowing fetus to excrete __; most of the umbilical vein's blood flows through the __ __ into the IVC-->___-->__ __-->La-->LV; small amount of blood goes to lungs for __ only; fetus gets O2 via __ from maternal circulation; fetal circulation leads to higher available O2 concentration to __/__, less to abd, leading to __ of development Embryonic/fetal development: lasts avg of __ lunar mos, __ wks, __ days; guidelines state the the __ to __ should be used to determine gestational age, but use __ __ if C-R length is over ___ mm; preembryonic state (first __ days of development)--> ___ stage (end of __ wk)-->fetal stage (until __)

lungs, gas, lungs, co2, ductus venousus, RA, foramen ovale, nourshinment, diffusion, brain/heart, cephalocaudal 10, 40, 280, crown, rump, HC, 84, 14, embryonic, 8, birth

Health beliefs: __-religious- health and illness are determined by __ forces such as god, __, spirits, or __; scientific/biomeidcal health paradigm: assumes __ explains all illness and life itself; holistic health belief: illness results when natural __ or __ is disturbed Mexicans use a __ to heal, Puerto Ricans may use __ (healer who communicates w/ __ for the physical and __ development of client) Ethnocentrism Touch and __ distance depend on __ Fasting doesn't include small children, __ women, __ adults, and sick individuals Complementary therapy: product/procedure that is used as an __ to conventional medical tx (__, __); alternative therapy: substance/procedure in place of __ medicine (ex. __ medicine) -Homeopathy: give medicine to __ symptoms, not __ symptoms -Naturopathy: utilizes __ forces of nature; combines safe and effective traditional means of preventing and treating human __ w/ the most current advances in modern medicine -Traditional chinese medicine: seeks to ensure balance of __ (__); includes acupuncture/__, __ therapy, __ (breathing/medication), __ __ -Chiropractor, ___ -Herbal meds

magico, supernatural, magic, fate, pathphysiology, balance, harmony curandero, espiritistas, spirits, emotional conviction that the values and beliefs of one's own cultural group are th best and only acceptable ones physical, culture pregnant, older adjunct, acupuncture, massafe, conventional, herbal, enhance, supress healing, disease energy, chi, pressure, herbal, qigong, tai chi massage

Teen Pregnancy -Assess/Diagnose: assess __ levels of teen; teen's developmental level and impact of pregnancy are reflected in degree of recognition of __ and __ involved in pregnancy/parenting; assess mom's ___, __ towards pregnancy, coping methods; assess knowledge of pregnancy -Plan/implement: early __ care is strongest and most critical determinant for reducing risk for teen mom and NB; teach in groups according to __; many teens prefer __ models to learn; all states permit __ testing/tx for ___ -Early adolescents tend to be __ and oriented to __, so they may not think their health/habits affect __; middle adolescents may be reluctant to ask questions; late adolescents can plan for __; gradual increases from prepregnant __ readings, along w/ __ weight gain must be evaluated as precursors to __; d/c planning should include info about resumption of __ and importance of __ Care of Parents over 25 -Medical risks: inc risk of __ over 35, higher over __; these women are more likely to have a __ medical condition that can complicate a pregnancy; rate of __, LBW, __ birth, __ higher; risk of __ __ increases (recommend that all pregnant women get screened); advanced paternal age is associated w/ adverse __ and __ outcomes, inc risk of __ - special concerns: generally more __ secure, but retirement strikes with college, so they'll fear they can't provide; may feel socially __ Care of pregnant women w/ special needs: high incidence of unplanned pregnancy with those that have __ disability, and they often seek prenatal care __

maturational, responsibilities, realities, self-concept, attitide prenatal, age,visual, confidential, STIs egocentric, present, fetus, future, diastole, excessive, preexlampsia, ovulation, contraception death, 40, chronic, miscariage, preterm, stillbirth, DS, fetal, neonatal, autism financially, isolated intellectual, later

Suppression of lactation: suppress via __ inhibition, which involves wearing __ __ bra within __ hrs of birth (wear continuously until lactation is suppressed, usually __-__ days, removed only for __); apply ice to __ area of breasts for __ mins 4x daily; avoid __ of breasts until sensation of fullness has passed, avoid __ Maternal Rest/Activity: -Relief of fatigue: fatigue can reduce _ __; energy needed to assume new __; sleep when baby sleeps; severe ongoing fatigue might be __ problems, can be r/t __ __ __; some are at higher risk for __ - Resumption of activity: avoid __ lifting, excessive __ climbing, __ activity; __-__ naps/day; by second week at home, woman can resume __ house keeping, can resume nearly all activities by __-__ wks, return to work in __ wks; bleeding indicates overdoing it -Sex/contraception: can resume __ once __ is healed and __ flow has stopped (usually by __ wk); need __ b/c of vag dryness; may be __; will leak milk when __; by 3 mos PP, couples have returned to prepregnancy __ and sex activity; may have dec __ for several mos, esp if __ __ -Pharmacologic interventions: rubella (avoid pregnancy for __ days, assess titer in __ mos), TDAP (if not vaccinated during __), Rhogam (give __ vial within __ hr of birth; antepartum: one vial at __ wks in RH-__ women; after __, abortion/__ pregnancy; indicated if mom is RH-__ and baby is RH-__)

mechanical, well fitting, 6, 5-7, showers, axillary, 20, stimulation, heat milk flow, roles, thyroid, PPD, fatigue heavy, stair, strenuous, 1-2, 6 intercourse, episiotomy, lochia, 3, lube, painful, stimulated, interest, libido, BF 30, 3, pregnancy, 1, 72, 28, negative, amniocentesis, ectopic, negative, positive

Development of Placenta Placenta: means of __ and __ exchange between embryonic and maternal circulations; placental development/__ doesn't occurs until __ wk; develops at site where embryo attaches to __ wall, explansion continues until __ wks Maternal portion (__/__) vs fetal portion (__/___ Development begins with __ __, which make spaces in decidua __; spaces fill with maternal blood, __ __ grow into these spaces and differentiate, creating an ___ layer and inner layer, which __ out; divided into __-__ segments (septa) called __, which compartmentalize __ exchange Placental circulation: completion of maternal-placental-embryonic circulation occurs __ days after conception, when __ heart start to function; in fully developed placenta's UC, fetal blood flows through 2 __ to caps, and O2 rich blood flows through umbilical vein to __; late in pregnancy, soft blowing sound (__ souffle) can be heard over area of UC, in sync w/ fetal heart beat; can hear __ souffle above __ __ during late pregnancy, coordinated with __ heart beat Braxton Hicks: painless contractions that occur q __-__ mins; believed to enhance placental __

metabolic, nutrient, circulation, 3, uterine, 20 red, fleshy, gray, shiny, chorionic villi, basilis, CV, outer, thin, 15-20, cotyledons, gas 17, embryonic, arteries, fetus, funic, uterine, symphysis pubis, maternal 10-20, circulation

Care during vacuum assisted birth: applying suction cup to __; traction is applied in coordination w/ __ contraction, __ occurs, fetal head is born; shouldn't exceed __-__ mins, frequent pop offs should warrant reconsideration of technique; babies are at inc r/f __ Care during c birth: associated w/ inc neonatal __ problems, longer hospitalizations, inc complications in __ pregnancies, including placental __ problems and __ rupture, so it shouldn't be indicated for women desiring __ children, if less than __ wks, or when pregnancy dating is accurate if there are no medical indications; -Indications: __ __, placental __, genital __, UC __, failure to __, more than one previous __ __ -Past c births lead to inc risk of future __ rupture, bleeding problems, placenta __, neonatal __ __; -Horizontal abd cut usually used, type of uterine cut depends on need for c birth (most common __ __ __ incision is __ incision); can also use classic __ incision in upper portion of uterus (inc risk of rupture w/ subsequent pregnancies) -Prepare by putting in __ and establishing __, NPO, __ before surgery, abd prep, assess __ before/during surgery b/c __ position can lead to fetal __ (wedge under right side) -After birth, assess mom's VS q __ mins until stable, then q __ mins for 2 h, then q 4 h; eval perineal pad q __ mins for at least an hour, __ should be palpated to determine if its remaining firm; if mom had __ anesthesia, put her on her side to drain __ and assist w/ coughing q __ h for __ h, check sensation q __ mins until it has returned

occiput, uterine, descent, 8-10, jaundice resp, subsequent, attachment, uterine, multiple, 39, placenta previa, abruption, herpes, prolapse, progress, c birth uterine, prvia, resp distress low uterine segment, transverse, certical, cath, IV, antacids, FHR, supine, hypoxia 5, 15, 15, fundus, general, secretions, 2, 24, 15

Fetal growth occurs in 3 __ stages: growth by increase in cell __, increase in cell __/cell __, increase in cell __ alone; growing fetal and __ tissues requires inc quantities of nutrients, which are listed in __ (or __) - Dairy- __ 8 oz cups, meat- __ servings, grain- __-__ servings, fruits __-__ servings, veggies- 3-5 servings, fats as desired in __ Nutritional Requirements: RDA for almost all nutrients increases during pregnancy; amount __ with each nutrient -Calories: requirements don't change in __ trimester; during __ and __ trimesters, women should consume extra __ cals/day, which can come from adding __ milk servings and a serving of __ or alternative -Carbs: provide main source of __ and provides __ necessary for normal __ functioning; must increase in last __ trimesters, b/c body will break down __ if no carbs are available; carbs promote weight gain/__ of fetus, __ , other maternal tissues -Protein: needed for growth and development of __ tissues, like __ and __; esp important in last __ of pregnancy, where fetal __ is greatest; get __ g/day Minerals -Ca/P: involved in __ of fetal bones/teeth and ___ buffering; body absorbs and uses __ more efficiently during pregnancy; some Ca/P required during pregnancy, but most __ occurs during last __-__ mos; 1000 mg if over __, __ mg if under -Iodine: essential part of __ hormone, can get this through __ salt -Sodium: necessary for proper __ and regulation of __ balance; avoid excessive intake by limiting __ foods

overlapping, number, number, size, size, maternal, DRI/RDA 4, 3, 6-11, 2-4, moderation varies first, 2nd, 3rd, 300, 2, meat energy, fiber, bowel, 2 proteins, growth, placenta maternal, uterus, beasts, 1/2, growth, 60 minxeralization, A/B, calcium, calcification, 2-3, 19, 1300 thyroid, iodized metabolism, fluid, salty

Pelvic cellulitis (__): infection involving CT of __ __ or CT of all __ structures; infection ascends upward in pelvis by way of __ system in uterine wall, can lead to __; pelvic __ is most commonly found as __ mass in uterine __ and __ space; may have high __, chills, malaise, __, abd pain, __ tenderness; peritonitis: __ ill, severe pain, rapid/shallow __, pronounced __, excessive __, abd distension Perineal wound infection: redness, warmth, edema, __ __, gaping wound C birth wound infections: often associated w/ concurrent __; red, indurated, __, draining __ exudate - diagnose w/ physical exam and __ cultures, __ to r/o UTI -Tx localized wound infection w/ __ __ abx, __ baths, analgesics; if wound infection, open wound and __ it, irrigate w/ saline __-__x/day, cover w/ __ gauze -Tx endometriris w/ __ abx, generally show improvement in __ days, but abx are continued until pt has been __ and __ for 24 hrs -Parametritis and peritonitis: tx w/ aggressive __ therapy, __ ___ abx; continue until __ and __ for 24 hrs, should see improvement in a few days -Nursing: inspect perineum q __-__ h for signs of early __, use __ scale; note fever, malaise, __ pain, __ smelling lochia, __ uterus, tahchycardia; **BF NOT CI W/ INFECTION

parametritis, broad ligament, pelvic, lymphatic, peritonitis, abscess, plapable, ligaments, subdiaphragmatic, fever, lethargy, respirations, tachycardia, thirst purulent drainage endometritis, tender, purulent endometrial, urinalysis broad spectrum, sitz, drain, 2-3, clean IV, 2, aymptomatic, afebrile IV, broad spectrum, aymptomatic, afebrile 8-12, infection, REEDA, abd, foul, large,

Early PPH -Retained placental fragments: can cause early PPH, but is most common cause of late PPH; retention usually r/t __ separation of placenta during __ of fundus before __ placental separation; inspect placenta for __ and for evidence of missing fragments or __ on maternal side; uterine __ may be required to remove missing fragments; __ to determine fragments -Vulvar, vaginal, pelvic hematomas: __ occurs as a result of injury to a BV from birth trauma; soft tissue in area offers no __ and hematomas containing __-__ mL of blood may develop rapidly; risk factors: preeclampsia, __ term birth, __ labor, macrosomia; hematomas less than __ cm in size are managed w/ __ packs and analgesia, usually resolve in several __; for those that are larger and expand, surgery is needed to _ the bleeding vessel -Uterine inversion: prolapse of __ to or through the __ so that the uterus is turned __ __ after birth; manage w/ immediate __ of uterus in pelvis under __ anesthesia

partial, massage, spontaneous, intactness, cotyledons, exploration, sonography hematomas, resistance, 250-500, first, precipitous, 3, ice, days, ligate uterus, cervix, inside out, turning, general

Health Promotion during pregnancy -Exercise to prepare for birth : __ __ maintains pelvic __ and prevents/reduces __ strain (down dog), abd exercises (tighten abd muscles with each ___), partial sit ups; repeat __x; perineal exercises: __ strengthens __ __ muscles; sitting _ _ prepares _ _ for birth -Sex: no reason to limit, may have to limit __ if hx of __ labor; woman should be on her back after __ month of pregnancy -Immunizations: __ viruses (__, __) shouldn't be given during pregnancy b/c of __ effects -Herbs: no herbs other than __ during first trimester -Teratogens: fetus is at high risk for gross abnormalities during the __ trimester, when fetal __ are first developing, but some meds can also have teratogenic effect when taken in __/__ trimesters (tetracycline is associated w/ _ _ and depressed __ growth; sulfonamide can compete w/ __ attachment, increasing risk of __) -Smoking increases risk for __, IUGR, __ birth, LBW, SIDS, also causes __ ear infections and _ _ infections, decreases availability of __ to maternal/fetal __; FAS is characterized by growth __, __ anomalies, CNS dysfunction of varying __, __ disability; counsel women of child bearing age to avoid __ drinking b/c drinking after conception before pregnancy is known can be hazardous; limit caffeine to less than __ mg/day (1 x of coffee=__ mg, 1c of tea/1 chocolate bar=__ mg)

pelvic tilt, flexibility, back, exhale, 5, kegel, pelvic floor, cross legged, inner thigs intercourse, preterm, 4th live, MMR, varicella, teratogenic, ginger first, organs, 2nd/third, stained teeth, skeletal, bilirubin, jaundice miscarriage, preterm, middle, resp tract, O2, tissues, restriction, facial, severity, intellectual, heavy, 200, 100, 50

Critical factors in labor Birth passage: size of __ (inlet, __, outlet), type of pelvis, ability of cervix to __/__ and ability of vag canal and external opening of vag to ___; __ most favorable pelvis for birth Fetus: -Fetal head: contains __, base of skull, __ (roof) of cranium; vault isn't __, so they can change shapes and overlap (__); sutures include __, saggital, __, lamboidal; mentum=__, __-brow, __=ant fontalle, __=between ant/post fontanelle -Fetal attitude: relation of fetal __ to one another; fetal lie: relationship of __ axis (SC) of fetus to __ __ of mom (__ or __) -Fetal presentation: determines fetal lie by part of fetus that enters __ __ first; __ presentation normal, __ presentation occurs when butt/feet are presenting rather than __ (complete: ___ present, __-just butt, __-feet)

pelvis, cavity, dilate, efface, distend, gynecoid face, vault, fused, molding, frontal, coronal, chin, sinciput, bregma, vertex parts, cephalcaudal, SC, longitudinal, transverse pelvic pasage, cephalic, breech, head, feet/but, frank, footling

Care during episiotomy: incision of __ body to enlarge outlet; predisposing factors include __ and other __ positions that result in excessive/uneven __ of perineum; can prevent w/ perineal __, pulling back on legs while in __, side laying position for pushing, __ compresses on perineum, __ expulsion of baby -Procedure: just before birth, when __-__ cm of fetal had is showing during contraction, episiotomy is performed by making __ incision or __ incision; use __ or regional anesthesia; repair w/ __; may feel pressure/__; apply ice to __ for 20-30 mins, off for __ mins; inspect site q __ mins during 1st hour after birth to assess for redness/swelling; have woman in __ __ position w/ leg lifted to examine Care during forceps assisted birth: outlet forceps when fetal skull has reached __, fetal __ is visible, and sagittal suture is not more than __ degrees from midline), low forceps when leading edge of fetal skull is at __ or more, midforceps when fetal head is __; indicated in presence of any condition that threatens mom/fetus that can be relieved by __, including pulmonary __, infection, __, premature __ separation, nonreassuring __ status; must have fully __ cervix, ROM, known type of __, empty __; may caused facial bruising and perineal tearing; apply __ while pushing, may notice fetal __ r/t head __

perineal, lithotomy, recumbet, pressure, massage, lithotomy, warm, gradual 304, midline, midiolateral, local, stiches, tugging, perineum, 20, 15, side lying perineum, scalp, 45, +2, engaged, birth, edema, exhasition, fetal, dilated, pelvis, bladder, traction, bradycardia

Assessment of mom: focuses on maternal __ adaptation; asks mom about __, fatigue, __, pain, signs of complication -Vitals: should all be back to normal; __ can occur PP, __ elevation indicates infection -WEight: 2 days (loss of __-__ lbs), 6 wks (returning to __ weight); minimal loss if __ __, preeclampsia, poor diet -Breasts: nonBF may have mild tenderness, __ amt of milk expressed, but by __ wks, should be no tenderness and no milk; BF: full, __ nipples -Abd: __ days improved firmness (may have __ __ consistency, esp in __), striae pink/obvious, __ healing; __ wks: tone improves, __ fades, __ __ fades -Urinary: back to normal prepregnancy amount of peeing; eval for __ __ __, routine urinalysis WNL (may have some __ if BF) -Bowels: 2 days- may have some __, esp w/ hemorrhoids; 6 wks- return to normal (increase __/__ if problems) - Lochia: gone by __ wks (excessive lochia and clots indicate uterus is not properly __; passing tissue indicates possible __ __) -Uterus: should lower at normal rate; should be back to prepregnant size w/ almost completely restored muscle tone by __ wks (stays big w/ __) -Episiotomy: minimal bruising/tenderness -Hgb/Hct: __/__ by 6 wks (may need to continue __) -Bonding should be evident, __ should be met

physical, diet, rest preeclampsia, temp 12-20, prepregnancy, fluid retention, small, 6, erect 2, bread dough, multiparous, scar, 6, striae, linea nigra pelvic floor dysfunction, kteons discomfort, fluid, fiber 6, contracting, retained placenta 6, infection 11, 33, iron, needs

Care of Woman during version (turning of fetus, which is used to change fetal __ by abd or __ manipulation) most common type is __ __ version (breech-->__ through external manipulation of abd); start IV first to give __ in case of difficulty -Criteria for ECV: if breech or __ presentation is detected in __ weeks of pregnancy, must do an ultrasound to first locate the __ and to confirm __; do if pregnancy is at __+ wks, ___ is __, fetal breech is not __ -CI: maternal problems, complications of pregnancy, previous __ birth, multiple gestation, ___ FHR, fetal abnormalities -Nursing: obtain VS and __ NST; explain procedure; place __; monitor BP/HR frequently throughout procedure; fetal well being determine __, __ and for __ mins after using electronic fetal monitoring and ultrasound Care of woman during amniotomy (_____): requires __ to be inserted through cervix, at least __ cm of cervical dilation is required; make sure head is __ first, or else cord might get __ in gush of fluid; this __ labor b/c __ are released when membranes are ruptured, stimulating __; place in __ position, assess __ before and IMMEDIATELY after procedure (if drastic changes, check for __ cord); cleanse __ area, monitor temp q __ h, amniotic fluid is constantly produced, so woman won;t have __ birth Care of woman during amnioinfusion: warmed sterile __ __ or __ __ is introduced into uterus through _ __ __; increases volume of fluid in __ in which cord compression causes FHR __; gives extra cushion of __ and promotes inc __ to fetus; make sure that fluid that goes in is adequately expelled, which is done by counting __

presentation, intrauterine, external cephalic, cephalic, meds shoulder, later, placenta, position, 36, NST, reactive, engaged c, nonreassuring, reactive, semireclining, before, during, 30 AROM, amniohook, 2, engaged, prolapsed, shortens, prostaglandins, contractions, semireclining, FHR, prolapsed, perneal, 2, dry NS, LR, IUPC, oligohydraminos, decelereations, fluid, perfusion, pads

Signs of Pregnancy Subjective (__) changes: symptoms that woman experiences and reports, but can't be considered __ of pregnancy, b/c they can be caused by other conditions; includes __, NV, excessive __ (may be noted within a few weeks after first missed __), urinary frequency, changes in __, quickening (mom's perception of fetal __, occurs 18-20 wks after __, as early as __ wks if pregnant before Objective (__) changes: -Changes in pelvic organs: only changes detectable during first __ mos are caused by inc __ congestion, general enlargement/softening of body of uterus can be noted after __ wk, __ is palpated just above symphysis pubis at about __-__ wks gestation and at the level of umbilicus at __-__ wks -BH: commonly palpated after __ wks; uterine souffle (heard when auscultating abd over __; soft, __ sound that occurs at same rate as __ HR, cause by inc blood pulsating through __); can be confused w/ funic souffle, which occurs at same rate as __ HR and is a soft, __ sounds of blood pulsating through __ __ -Changes in pigmentation of skin; fetal outline can be palpated after __ wks gestation; balottement; __ tests Diagnostic (__) changes: fetal heartbeat can be detected w/ __ as early as __-__ wks pregnant, fetal movement after __ wk of pregnancy, visualization of fetus by ultrasound (can see __ sac by __-__ wks gestation, fetal parts/movement can be seen at __ wks gestation; transvaginal can detect gestational sac as early as __ days after implantation

presumptive, proof, amenorrhea, fatigue, menses, breasts, movement, LMP, 16 probable, 3, vascular, 8th, fundus, 10-12, 20-22, 28, uterus, blowing, maternal, placenta, fetal, blowing, UC 24, passive fetal movement elicited when examiner inserts 2 gloved fingers into vagina, pushes against cervix, pushing body up, and feeling baby rebound, pregnancy positive, doppler, 10-12, 20, gestational, 4-5, 8, 10

Physiology of labor Labor onset causes: -__ withdrawal: __ relaxes uterine smooth muscle; toward end og __, __ availability is decreased, and __ is better able to stimulate contractions -__ __ __ increases throughout pregnancy, with sharp increase at term; CRH stimulates synthesis of ___ and __, which stimulate labor Myometrial activity: myscles of __ uterine secment shorten and exert pull on __ w/ each contraction, causing __ (drawing up of cervical canal into side walls of __ and turns cervix paper thin); uterus __ w/ each contraction, decreasing horizontal diameter, __ fetus Difference between true/false labor: true labor contractions produce progressive __ and __ of cervix; occur __ and increase in frequency, __, intensity; contractions start in __ and go to __; false labor contractions don't produce __ and __; irregular, don't increase; discomfort in lower __ and __ (relived by walking, lots of __, shower)

progesterone, progesterone, gestation, progesterone, estrogen corticotropin releasing hormone, PGE, PGF upper, cervix, effacement, uterus, elongates, straightening dilation, effacement, regularly, duration, back, abd, dilation/effacement, abd, groin, water

- If IV analgesics are given too early, they can __ labor and __ fetus; dose at __-__ cm for primigravida, __-__ cm for multipara; if given too late, it won't be much relief for mom and will cause neonatal __ __; must ensure normal __, term fetus, __ present, established __ pattern, progressive fetal descent -__ most commonly used for epidural; assess/reassess BP (hypotension tx: __/__, IV bolus, 8-10 lpm, ephedrine __-__ mg (ordered by anesthesiologist)); direct correlation between __ and dec __ -PROM: IV __ therapy; put on bedrest, NST/__/__ as necessary -Amnioinfusion: continuously monitor __ -Cervical ripening: __ is thin piece of cardboard w/ a string, releases med over __ h to increase cervical ripening, should decrease need for Pitocin (take out if too many contractions- ___); give __ (a tocolytic) if contractions are more frequent than __ mins apart (absolute minimum); __ (cytotec): __ mcg q 3-6 h, very small tab placed vaginally; CI w/ __, contracting already q 3 mins, hx of C birth (increases risk for __ __); assess contraction frequency, maternal __, continuous FM; -C birth indications: complete __ __, cephalopelvic disproportion, active __ __, multiple gestation (__ fetuses), UC prolapse, failure to progress, __ FHR, previous __ incision on uterus

prolong, depress, 4-5, 3-4, resp depression, FHR, varability, contraction bupivacaine, LLR, trendelendberg, 5-10, hypotension, FHR abx, BPP, EFM FHR cervadil, 12, tachysystole, terbutaline, 2, misoprostol, 25, asthma, uterine rupture, vitals, placenta previa,, genital herpes, 3+, nonreassuring, classival

Zinc: needed for __ metabolism and synthesis of __ and __; essential for normal fetal growth and __; __ mg/day if over 19 Mg: essential for cellular __ and __ growth; __ mg/day if over 19 (milk, __ grains, __ __ veggies, nuts) Iron: requirements inc during pregnancy b/c of growth of __ and __ and inc maternal blood volume; iron deficiency anemia can lead to ___ birth, __, infant __; __ demands for iron further contribute to symptoms of __ in pregnant woman; fetal liver stores iron starting in __ trimester; __ meats, __ __ veggies, eggs, __ grain bread, __ fruits; combine w/ vit __ for greater absorption; RDA __ mg/day, take __ mg supplement in 2nd and 3rd trimesters Fluid: necessary for many reactions, serves as __, medium for __ to carry substances, aid in __ control; __-__ 8 ox glasses of fluid/day (at least __-__ of these should be water) Vegetarianism: lactoovegetarians, lactovegetarians, vegans; must get enough __, __ (hard if vegan b/c they eat a lot of __, which is filling); supplement __ mg of __ if vegan, since they don't eat animal products, supplement __ and vit __ if they don't drink soy milk)

protein, DNA/RNA, lactation, 11 metabolism, structural, 250, whole, green leafy fetus, plaenta, premature, LBW, mortality, fetal, anemia, 3rd, lean, green leafy, whole, dried, C, 27, 30 lubricant, transport, temp, 8-20, 4-6 include milk/dairy/eggs, include dairy, but not eggs; pure vegetatians and don't eat food from animal sources; protein, calories, fiber, 4, b12, calcium, D

Fetal assessment Position/Presentation: -inspection: observe __/__ of abd, assess lie of fetus by noting whether uterus projects ___ and __ (longitudinal) or left to right (__) -Palpation: __ maneuvers (may be difficult if __, too much __ __, full bladder); 1st: face woman, palpate __ __ w/ both hands, head is __, __, moves independently, butt is __, moves w/ __; 2nd: move hands over __, palpate abd w/ gentle, but __ pressure, back feels __, extremities feel __; 3rd: 1 hand above __, analyze if it feels like head or __; 4th: facing woman's feet, place hands on lower abd, move hands towards pubis, note __ Auscultation of FHR: ___ to determine between, __, after contractions; __ can be used after __ wks (use leopold maneuvers to determine where fetal __ is to best hear FHR); count for __-__ s x2 Scalp stimulation: apply pressure to scale during __ __; fetus who is not in distress responds w/ __ of FHR, fetuses that fail to respond have increased incidence of __, hypoxia, low __ Cord blood analysis at birth: clamp cord before baby takes first breath, aspirate blood from __ __; normal pH should be above ___ (lower if acidosis and __); perform if ___ stained amniotic fluid, abnormal __ patterns, APGAR less than __ at __ mins

size, shape, up, down, transverse leopold, obese, amniotic fluid, upper abd, round, firm, softer, trunk, pelvis, deep, smooth, knobby, symphysis, breech, brow dopple, during, fetoscope, 20, back,20-30 vag exam, accelerations, acidosis, APGAR umbilical artery, 7.24, meconium, FHR, 7, 5

__ infection is infection of __ tract associated w/ childbirth that occurs up to __ wks PP; most common type is __, which is limited to uterine lining; infection can spread via __ and __ system to become progressive disease resulting in parametrial __ and __; infection common among those w/ c birth (give __ __); standard definition of puerperal morbidity: temp of __ or higher, with temp occurring on any __ of first PP days, exclusive of first __ hrs, when taking temp at least __x/day; will manifest after __ PP Endometritis: inflammation of __ occurs up to __ wks PP, common in those who have c birth after extended pd of __ and ___; infection from vag delivery primary affects the placental __ site and adjacent __; bacteria that colonize the __ and vagina and gain access to __ __ during labor/PP and begin to invade the __ tissue (lacerations, incision, lower __ segment); clinical findings of metritis in initial 24-36 hrs PP tend to be r/t __ __ __, late onset r/t genital __ and __ -Risk factors for PP __ infection include __ birth, prologed __ ROM, prolonged __ preceding c birth, multiple __ exams, compromised health, __ assisted birth, __ removal of placenta, retained __ -S/s: __ smelling lochia, fever (__-__), uterine __ on palpate, __ abd pain, tachycardia, chills; prevent w/ __ abx for c birth

puerperal, repro, 6, endometritis, lymph, circulatory, cellulitis, peritonitis, prophylactic abx, 100.4, 2, 24, 4, discharge endometrium, 5, labor, ROM, implantation, myometrium, cervix, amniotic, fluid, devitalized, uterine, group b streptococcus, mycoplasms, syphylis uterus, premature, labor, vag, instrument, manual, placenta foul, 101-104, tenderness, lower, prophylactic

Nursing Care after c birth: -Chances of __ infection are increased b/c of __ and b/c of altered immune response; cough/deep breathe q __-__ h until ambulating frequently; leg exercises q __ h; give __ PRN, esp during first __-__ hrs after birth (allows for inc mobility), epidural gives __-__ hrs of pain relief; promote comfort through __, massage, reducing bad odors; teach to __ incision when ambulating -Monitor surgical dressing/incision using REEDA -Bonding: during taking in phase, parents are __ their role and may be nurturing __and each other; taking hold by day __ or __ Surrogacy: after birth, the mom needs to complete a __ process to work through her loss, __, guilt, other feelings Special populations: -Obesity: special attention to prevent __, __ complications, __ disease, infection; assess for __ obstruction, __ ASAP to prevent pneumonia, use of __ -Lesbian: non pregnant lady assumes __-___ role -Developmental disability: material should be presented in easy to __ format; peer mentors helpful; perform __ assessment and make resources available

pulmonary, immmobility, 2-4, 2, analgesics, 24-72, 16-24, positioning, splint redness, edema, ecchymosis, discharge, approximation of incision grieving, lonliness injury, resp, thromboembolic, airway, ambulate, SCDs co-mothering understand, needs

Considerations for home visit: prepare by identifying __ of home visit, gather necessary materials -Purpose/timing: PP home care is focused more on __, teaching, facilitating __, and counseling, than on __ care; assess for __, nurse assess adjustment and parent's __; ascertain current __ needs and offer requested info in more relaxed setting; eval __ health -Maintaining safety: inform family when you'll be coming and ask them to call a supervisor if you don't get there in __ mins -Fostering caring relationship w/ fam: regard for clients (be __, introduce self, ask __ before sitting), genuineness (make sure __ and __ messages match, be __, be prepared), empathy (be __ to what they're saying), trust/rapport (follow through/__ __ PRN) During first visit, nurse completes a __ assessment of mom and a __ assessment of fam

purpose assessment, learning, physical, complications, skill, informational, mental 15 polite, permission, verbal, nonverbal, nonjudgemental, attentive, f/u physical, psychosocial

Stages of labor 1st stage -Latent: beginning of __ contractions (mild), increase in __, duration, __, last __ s q 10-__ mins; progresses to __-__ s q 5-7 mins; lasts __ hrs in first baby, 5 hrs in second; __ or artificial ROM -Active: intensification of contractions and pain; cervix dilates from __-__ cm, fetal descent is progressive -Transition phase: contractions q __-__ mins, duration of 60-90 s, strong intensity; dilates __-__ cm, rate of fetal descent __ increases 2nd stage: begins w/ __ cervical dilation, ends w/ birth of baby -Contractions q __-__ mins, duration of __-__ s; will fee need to push; __ recedes between contractions, but actually descends more w/ each contraction -__ occurs when fetal head is encircled by __ opening; as fetal head distends __, the perineum becomes extremely __ and anus stretches and __; -Cardinal movements of labor: __, flexion (fetal chin flexes into __ b/c of resistance), __ rotation (fetal head must rotate to fit diameter of __ __), extension (of fetal head as it passes under __ __), restitution (turning head to one side after head is __ and neck untwists, allowing head to align w/ back in __ __), external rotation (head turns further to one side as shoulders rotate to __ position in pelvis), expulsion (__ shoulder before __ shoulder)

regular, intesnsity, frequency, 30, 10-30, 30-40, 9, spontaneous 4-7, 1/5, 8-10, dramatically 1/5-2, 60-90, head crowning, external, thin, protrudes descent, chest, internal, pelvic cavity, symphysis pubis, delivered, birth canal, anteroposterior, anterior, posterior

-High mercury: __, mackerel, swordfish -Korean: PP may have __ __ and __ soup to cleanse and increase __ __ production -BMI= -Kick counts starting at __ wks -__ can cause contractions -Estrogen/progesterone increased during pregnancy, balance favors __/__ after birth -Can detect FHR w/ __ probe at __ wks -Cervix feels like __ before pregnancy, feels like __ during pregnancy -Increased __ causes Goodell's (__) and chadwick's (__/__) -Colostrum: production at __-__ wks of pregnancy -Hct below __- put on iron -__ during pregnancy (inc WBCs) -__ state r/t inc clotting factors and __; get the OOB and walking around -__ __ syndrome=supine hypotension -Relaxation of pelvic joints r/t hormone __ -GB- first trimester- dec __ time, increased __ levels, may cause __ __ - ok if premature contractions are less than __/hr, just get off feet -NT done before __ wks; if more than __ mm, confirm w/ CVS or __ -Introspection?

shark roast beef, seaweed, breast milk lbs/inches^2*703 28 UTI oxytocin, prolactin vag, 8 nose, lip vascularization, softening, blue/purple 12-16 11 leukocytosis hypercoagulable, fibrinogen vena cava relaxin emptying, cholesterol, gall stones 6 13, 3, amnio

A&P of Pregnancy Reproductive System: -Uterus: before pregnancy, uterus is small, almost __, __ shaped organ, weighs __ oz; after pregnancy, it weight __ lbs, has capacity of __ L; change in size response to stimulating influence of __ and distension of growing fetus; BH are __, __ and occur intermittently throughout pregnancy (can be felt starting at __ mos) -Cervix: __ stimulates inc in cell __, glands secrete thick, sticky mucus that accumulates to form __ __, expelled at dilation; __ of cervix (__ sign), __ discoloration (__ sign) -Vagina: __ causes thickening of mucosa, increase in vag __, which are __ to prevent infection, but favors growth of __ -Breasts: enlarge, glands increase in __ and __ to prepare for lactation, nipples more __, areolae darken, __ may develop; __ may leak or be expressed during __ trimester Resp system: progesterone decreases airway __, inc __ consumption; uterus presses upward and elevates __, ribcage flares; __ and __ r/t estrogen induced edema, __ of mucus GI: NV from elevated __, relaxation of smooth muscle of __, may have excessive saliva production (__); elevated progesterone slows gastric __ and decreases __, leading to constipation GU: uterus against bladder in __ trimester, not as bad __ trimester, frequency reappears in __ trimester; GFR __, may see __

solid, pear, 2, 2.75, 5, estrogen, ireegular, painless, 4 estrogen, number, mucous plug, softening, goodell, bluish, chadwick's estrogen, secretions, acidic, yeast size, number, erect, striae, colostrum, last resistance, O2, diaphragm, epistaxis, stuffiness, hypersecretion hCG, stomach, ptaylism, emptyism, peristalsis 1st, second, third, increased, glycosuria

Electronic FHR monitoring : do if previous __, presence of complication, __ of labor, preterm labor, dec __ __, meconium stained __ __; can do external monitoring via ___, internal monitoring requires an internal __ __ on fetal __ (more accurate continuous data b/c signal is __ and __ of fetus/mom doesn't interrupt -Baseline: avg FHR rounded to increments of __ bpm over __ min pd of monitoring; __ patterns aren't associated w/ contractions, __ patterns are; __ is change in FHR over a few s to a few mins; fetal tachycardia over __, marked tachycardia over __ (may indicate __, maternal__, maternal __, maternal hyperthyrodism, fetal __); bradycardia is less than __ during 10 min pd (__ hypoxia, maternal __, prolonged UC __, uterine __, uterine rupture, maternal ___) -Baseline variability: measure of interplay between __/__ NS over __ min pd; reflects baseline __ that are __ in frequency and amplitude variability as follows: greater than __ bpm, mild __-__ bpm, minimal: less than __ bpm, absent; reduced variability indicated fetal __ and can be r/t hypoxia, __, sedatives, fetal arrhythmias, __ insult, less than __ wks gestation; __ variability w/ early hypoxia, fetal __, advancing __ age, stimulants -Accelerations: transient increases in FHR, normally caused by fetal __; often accompany __ -Decelerations: periodic decreases in FHR from normal __; categorized r/t time of occurrence w/ __ and __; early occurs before __ of contraction, benign, doesn't require __, r/t dec __ blood flow; late: ___ insufficiency resulting from dec __ __ and __ transfer to fetus during __ (commonly result of maternal __ from __), occurs after onset of uterine contraction, will need ____ if they continue; variable: occur if cord gets __, leading to fetal __, slowing FHR, varies w/ timing of contraction

stillbirth, induction, fetal movement, amniotic fluid, ultrasound, spiral electrode, occiput, clearer, movement 5, 10, episodic, periodic, variability, 161, 180, hypoxia, dehydration, fever, anemia, 110, late, hypotension, hyperstimulation, hypothemrmia sympathetic, parasympathetic, 10, fluctuations, 25, 6-25, 5, compromise, sleep, neuro, 32, marked, stimulation, gestational movement, contractions baseline, contractions, waveform, peak, intervention, cerebral, placental, blood flow, o2, hypotension, epidural, c birht compressed, HTN,

Categories of genetic tests: diagnostic (establish diagnosis of genetic disorder in person who is __ or has __ screening), prenatal (identify __ w/ genetic condition), __ screening (identify presence of __ that requires __ initiation of tx to rpevent death/__), PGS, __ testing, __ (tests for disease that if present, will likely cause __ later on); screening tests for everybody, common false __ b/c tests are very sensitive; diagnostic test if ___ Prenatal testing: -Genetic Ultrasound: may be used to assess __ for genetic/__ problems; can visualize fetal __, __ defects, __ malformations, GI malformations, renal malformations, __ malformations; best done at __-__ wks when fetal structures have __ developed; the larger the nuchal __, the higher change of __ -Maternal serum screening: measures specific hormones and __ in maternal serum to determine risk for __ __, trisomy 18, __ __ -Noninvasive prenatal testing: examines fetal __ circulating in maternal serum, can detect __; can be used for screening, not diagnosis - Genetic amniocentesis: needle inserted into __ __ under ultrasound guidance and small amt of amniotic __ is collects; fetal cells can be __ and __; CVS: tiny amt of __ __ of fetal origin obtained with needle, performed after __ wks -Amniocentesis/CVS indicated if over __, previous kid with __ abnormality, parent carrying __ abnormality, mother with __ linked disease, parent with inborn error of __, both parents containing autosomal __ disease, fam hx of __ __ defects -Percutanous __ __ sampling

symptomatic, positive, fetus, NB, immediate, disaability, carrier, presymptomatic, symptoms, positives, s/s fetus, congenital, head, cranispinal, thoracic, skeletal, 16-20, translucency, defect proteins, DS, SB DNA, defects amniotic fluid, fluid, cultured, tested, placental tissue, 9, 35, chromosomal, chromosomal, x, metabolism, recessive, NT umbilical blood

PP Physical adaptations: repro -Lochia (d/c of __ debris): rubra is __ __, occurs for first __-__ days and contains __ cells, WBCs/RBCs, etc; few small __ no larger than __ are common, particularly in first few days after birth, but investigate if clots are large; __ is pink, follows from day __-__, RBC component decreases gradually, and __/__ d/c persists for additional week or 2 (___; composed of WBCs, __, __ cells, cholesterol, bacteria; has musty, __ odor (foul if infection)); total lochia volume is __ mL, decreases each day, less if __ birth and __ child -Vag changes: after birth, vag appears ___ and __, may have bruising; size decreases in __-__ wks, appears normal by __ wks if not BF; can do __ exercises to improve __ and __ -Perineal changes: may appear __ w/ some bruising; healing of __/__ occurs in 2-3 wks after birth, but may not heal completely for __ mos -Reoccurence of ovulation/menstruation: menstruation can return in __ wks, definitely by __ wks in nonlacting moms, may not be until __ yrs if BF; return of ovulation r/t serum __ Abd: flab responds to exercise within __-__ mos; distasis recti abdominis may occur, esp in women w/ poor __ muscle __; improvement depends on __, spacing of __, __ of pregnancies; ___ fade

uterine, dark red, 2-3, epithelia, clots, nickel, serosa, 3-10, creamy, yellow, alba, fat, epithelial, 250, c, first edematous, gaping, 3-4, 5, kegel, tone, contractility edematous, episiotomy/laceration, 6 7, 12, 3, progesterone 2-3, abd, tone, exercise, pregnancies, #, striae

-Although __ analgestics and regional __ blocks may affect fetus, so do the laboring mom's __ and __ -Systemic medications (only for __ risk, healty moms); goal of pharmacologic __ is to provide maximum pain __ at minimum risk for __ and __ (determine how fast med will cross __ barrier, med action in body depends on rate at which substance is metabolized by __ and excreted by __; high doses may remain in fetus for long pds of time b/c of immature __/__ funciton -Nursing: pain relief given too early may prolong __ and __ fetus; if given too late, it may cause resp __ in NB; assess maternal __ __, FHR, presence of __, normal fetal __, fetus is term; IV works in a few __ Opioids: primary action in brain, activating neurons that descend to __ __; analgesics used in __ labor are given in intermittent doses -Butophanol tartrate (__) and nalbuphine (__): stadol is an __-__ opioid analgesic agent, which reduces pain __; can cause resp __ of mom/baby if given late in __ stage of labor (give __); can cause __, dizziness, fainting, __; Nubain is also __-__ can can ppt __, crosses __ and cause bad __ and fetal resp __, yet Nubain is still preferred because is causes less __/__ and more __ effect; both can have __ effect -Fentanyl: less neonatal __ depression than __ b/c it doesn't cross placenta

systemic, spinal, pain, contractions, low, analgesia, relief, mom, fetus, palcental, lier, kidneys, liver kidney labor, depress, depression, VS, movement, minutes SC, early, stadol, nubain, agonist, antagonist, intensity, depression, late, early, drowsiness, hypotension, agonist-antagonist, withdrawl, placenta, FHR, redpression, N/V, sedative, analgesic resp, demerol

Second/Third trimesters (usually don't appear until __ trimester in __ pregnancy, but occurs earlier w/ each subsequent pregnancy) -Heartburn (__): r/t displacement of stomach, inc production of __, dec GI ___, relaxation of __ sphincter may also contribute; liquid forms of low __ antacids to tx; can give __ agent (__, omeprazole) if __ are ineffective -Ankle edema: increasing difficulty of __ ___ from LE; prolonged sitting/standing -Varicosities: result of __ of vein walls or __ __; can relieve pressure on __ __ by turning to side; elevate legs __, avoid crossing at __ -Flatulence: dec __ motility, delayed __, pressure on LI -Hemorrhoids: __ of veins in lower __ and __; itching, swelling, pain, bleeding; will usually go away a few __ after birth; can get relief by pushing hemorrhoid back into place; contact HCP if they get __ or __ -Constipation: __, displacement of intestines, oral __ (may need __ __) -Backache: maintain good __, use proper mechanics -Leg cramps: stretching provides __ relief (straighten knee, pull foot up); maintain calcium and __ in diet to dec cramps -Faintness: r/t changes in blood __ and __ hypotension; slowly change positions; if job requires prolonged __, marching in place to inc __ __ -SOB: worsens in last trimester; get relief when __ occurs in last few weeks as the __ and __ move down in pelvis -CTS: numbness/tingling in hand near __ caused by compression of __ nerve; tx involves __ and avoiding aggravating/__ movements

third, 1st pyrosis, progesterone, motility, cardiac, sodium, antisecretory, rantidine, antacids venous return weakened, faulty valves, pelvic veins, frequently, knees GI, emptying varicosities, rectum, anus, days, tender, hardened progesterone, iron, stool softeners posture immediate, phosphorus volume, positional, standing, venous return lightening, fetus, uterus thumb, median, splinting, repetative

-If baby has __, they may have brain bleed after vag delivery -Preeclampsia can lead to __, decreasing blood flow to baby -BPP: fetal __, AF volume, __ NST, fetal __, __ body movements; gives idea of __ fetal status -If OP, provide counter pressure on __ area to relieve pain; most babies are __; if shoulder presents, baby is __; if butt comes out first, __ may strangle baby -Fetal attitude: relationship of body parts; head should be flexed __ w/ chin resting on __, arms and legs flexed; if neck is __, stat c birth -ECV at __ wks gestation; must have __ NST, baby not __; give __ if client is contracting; keep mom on monitor for __ mins after version -Increased fetal production of __ and __ decreases progesterone and increases __ -__ aspiration can lead to penmonia -Circumcision on jewish people on day __-__, important day of religion - First time moms can push for __-__ hrs -Confirm ROM with __ paper, ___, or positive __ -__ measures contractions, __ transducer measures FHR -IUPC to determine ___ of contractions; use if mom is __ -If baby is cephalic, auscultate FHR in __ __ of maternal abd

thrombocytopenia, vasocontriction HR, reactive, tone, gross, comprehensive lumbar, OA, transverse, cervix forward, chest, hyperextended 36, reactive, engaged, tocolytic, 60 glucocorticoids, androgens, prostaglandins meconium 7-8 2-3 nitrazine, amniosure, ferning tocotransducer, ultrasound, adequacy, obese lower quad

Development of family attachment Maternal-NB attachment behavior: -Following characteristics are important: level of __, level of __-__, capacity for enjoying herself, adequacy of __ about __ and rearing, prevailing mood or usual feeling tone, reactions to present __ -Initial behavior: new mom will demonstrate fairly regular pattern of __ behaviors as she continues to familiarize herself w/ her NB through __; she arranges herself or NB so that she has direct __ to __ or __ to __ contact (__ face position), responds __ to NB sounds - During first few days after birth, the new mom applies herself to getting to know her baby (__ phase), mom will feel __ when responding to needs, during phase of mutual __, mom and baby seek to determine the degree of __ each partner in their relationship will exert; __ achieved when mom and baby __ each others company Father-NB: characteristic sense of __, preoccupation, __ in baby demonstrated by fathers during early contract is termed __ Culture: some cultures avoid __ after birth, some avoid __

trust, self-esteem, knowledge, childbearing, pregnancy maternal, touch, face to face, eye to eye, verbally acquaintance, competent, regulation, control, reciprocity, enjoy absorption, interst, engrossment hot, cold

Maternal assessment of fetal activity: __ fetal activity provides reassurance of fetal well being and that dec activity indicates possible __ requiring immediate f/u; can start evaluating at __ wks; obtain fetal movement __ (FMC); have woman keep fetal movement __ (FMR) using count to __; fetal movements directly r/t fetus' __-__ cycles and vary from __ sleep-wake cycle; after __ wks, fetus spends __ of its time sleeping -Count to 10 at same __ each day, preferably after __, lie quietly in __ __ position, mark w/ x for each fetal movement until she records __ (usually __x in __ h); have woman count __x/day for 20-30 mins, if fewer than __ movements, count for __ hr; contact HCP if deviation from normal movement Ultrasound: ultrasonic waves deflect off tissues, showing structures of varying __; limited by fetal __ -Transabdominal: often scanned w/ __ bladder b/c examiner can assess other structures, esp __ and __, in relation to bladder (important to see lower portion of __ and __ when vag bleeding is noted -Transvaginal: uses __, which is close to structures being imaged, so it produces a __, more __ image than possible w/ the __ approach; can see structures/fetal characteristics __ in pregnancy w/ this approach, can help predict __ labor; can be accomplished w/ __ bladder - Clinical applications: can visualize __ sac and FHR at __ wks gestation, observe fetal __ movement, measure diameter of fetal __/__ length to assess growth patterns; estimate growth rate (macrosomia- greater than __ g at birth, LBW- less than __ g at birth), detects __ anomalies, examines __ __ in 1st trimester to assess for DA, examines fetal __ structures, length of fetal __ bone (short in __ __), identification of __ __ volume and amniotic fluid __, location of __

vigorous, compromise, 28, count, record, 10, sleep wake, maternal, 38, 75% time, meal, side lying, 10, 10, 3, 3, 1, densities, position full, vagina, xercix, uterus, cervix, probe, clearer, detailed, transabdominal, earlier, preterm, empty gestational, 6, breathing, head, femur, 4000, 2500, fetal, NT, nasal, DS, amniotic fluid, index, placenta